Provider Demographics
NPI:1780363473
Name:ELIEZER, SHIMON
Entity type:Individual
Prefix:
First Name:SHIMON
Middle Name:
Last Name:ELIEZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 PGA BLVD LOT 374
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2956
Mailing Address - Country:US
Mailing Address - Phone:772-985-4042
Mailing Address - Fax:
Practice Address - Street 1:784 US HIGHWAY 1 STE 19
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4411
Practice Address - Country:US
Practice Address - Phone:772-985-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52653225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist