Provider Demographics
NPI:1194993493
Name:GARDENS PHYSICAL MEDICINE LLC
Entity type:Organization
Organization Name:GARDENS PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCUDERI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-775-4900
Mailing Address - Street 1:4383 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6253
Mailing Address - Country:US
Mailing Address - Phone:561-775-4900
Mailing Address - Fax:561-775-0003
Practice Address - Street 1:4383 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6253
Practice Address - Country:US
Practice Address - Phone:561-775-4900
Practice Address - Fax:561-775-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG925Medicare PIN