Provider Demographics
NPI:1104933084
Name:BOCA RATON ORTHOPEDIC GROUP INC
Entity type:Organization
Organization Name:BOCA RATON ORTHOPEDIC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HORNBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-391-5515
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-391-5515
Mailing Address - Fax:561-347-7470
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:SUITE 460
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6465
Practice Address - Country:US
Practice Address - Phone:561-391-5515
Practice Address - Fax:561-347-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4025940001Medicare NSC
FL99743Medicare PIN