Provider Demographics
NPI:1063527281
Name:SEA BLUE NEUROLOGY CENTER, PA
Entity type:Organization
Organization Name:SEA BLUE NEUROLOGY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-796-9060
Mailing Address - Street 1:PO BOX 25926
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33320
Mailing Address - Country:US
Mailing Address - Phone:954-796-9060
Mailing Address - Fax:954-796-9061
Practice Address - Street 1:3100 CORAL HILLS DR
Practice Address - Street 2:SUITE 308
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4137
Practice Address - Country:US
Practice Address - Phone:954-796-9060
Practice Address - Fax:954-796-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME878972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
81087OtherBLUE CROSS BLUE SHIELD
7229240OtherCIGNA HEALTH CARE
1044955OtherCAREPLUS HEALTH PLAN
197019OtherAMERIGROUP
293244OtherAVMED HEALTH PLAN
=========OtherCOMERCIAL PPO EPO
=========OtherGREAT WEST HEALTHCARE
1044955OtherCAREPLUS HEALTH PLAN
=========OtherFREEDOM PLAN & PLUS PLAN
=========OtherHUMANA INC
197019OtherAMERIGROUP
293244OtherAVMED HEALTH PLAN
=========OtherAMERICAN HEALTH CHOICE
=========OtherFIRST HEALTH NETWORK
7229240OtherCIGNA HEALTH CARE
=========OtherCHOICE CARE NETWORK
=========OtherINDEMNITY PLAN PPO
=========OtherJMH HEALTH PLANS
=========OtherCORVEL
=========OtherFIRST HEALTH WORKERS COMP