Provider Demographics
NPI:1649635335
Name:BRAD NITZBERG MD
Entity type:Organization
Organization Name:BRAD NITZBERG MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NITZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-755-1946
Mailing Address - Street 1:5401 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4636
Mailing Address - Country:US
Mailing Address - Phone:954-755-1946
Mailing Address - Fax:954-755-7789
Practice Address - Street 1:5401 N UNIVERSITY DR
Practice Address - Street 2:SUITE 203A
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4636
Practice Address - Country:US
Practice Address - Phone:954-755-1946
Practice Address - Fax:954-755-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE13091Medicare UPIN
FL09532Medicare PIN