Provider Demographics
NPI:1841504719
Name:PALM BEACH SPINE SPECIALISTS
Entity type:Organization
Organization Name:PALM BEACH SPINE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:X
Authorized Official - Last Name:MONTESANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-833-4869
Mailing Address - Street 1:11000 PROSPERITY FARMS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3462
Mailing Address - Country:US
Mailing Address - Phone:561-833-4869
Mailing Address - Fax:561-833-4872
Practice Address - Street 1:11000 PROSPERITY FARMS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3462
Practice Address - Country:US
Practice Address - Phone:561-833-4869
Practice Address - Fax:561-833-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85035207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty