Provider Demographics
NPI:1770579138
Name:SOUTH FLORIDA NUCLEAR MEDICINE
Entity type:Organization
Organization Name:SOUTH FLORIDA NUCLEAR MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:PEVSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-750-8965
Mailing Address - Street 1:1599 NW 9TH AVE
Mailing Address - Street 2:204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1599 NW 9TH AVE
Practice Address - Street 2:204
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1310
Practice Address - Country:US
Practice Address - Phone:561-750-8965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19375261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40193Medicare PIN
FLCM0843Medicare PIN