Provider Demographics
NPI:1649912478
Name:PHYSICIAN SURGICAL NETWORK INC.
Entity type:Organization
Organization Name:PHYSICIAN SURGICAL NETWORK INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-248-3422
Mailing Address - Street 1:831 CORAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4180
Mailing Address - Country:US
Mailing Address - Phone:954-248-3422
Mailing Address - Fax:
Practice Address - Street 1:7350 SANDLAKE COMMONS BLVD STE 1130
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8039
Practice Address - Country:US
Practice Address - Phone:407-870-1579
Practice Address - Fax:407-870-2353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN SURGICAL NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty