Provider Demographics
NPI:1811679103
Name:TGPN M2 LLC
Entity type:Organization
Organization Name:TGPN M2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-331-0808
Mailing Address - Street 1:6415 LAKE WORTH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3009
Mailing Address - Country:US
Mailing Address - Phone:561-331-0808
Mailing Address - Fax:561-594-0880
Practice Address - Street 1:4620 PGA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3991
Practice Address - Country:US
Practice Address - Phone:561-832-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty