Provider Demographics
NPI:1982263638
Name:BOCA RATON PODIATRY AND SPORTS MEDICINE INSTITUTE
Entity Type:Organization
Organization Name:BOCA RATON PODIATRY AND SPORTS MEDICINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-416-1196
Mailing Address - Street 1:5458 TOWN CENTER RD STE 17
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1009
Mailing Address - Country:US
Mailing Address - Phone:561-416-1196
Mailing Address - Fax:561-416-1822
Practice Address - Street 1:5458 TOWN CENTER RD STE 17
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1009
Practice Address - Country:US
Practice Address - Phone:561-416-1196
Practice Address - Fax:561-416-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty