Provider Demographics
NPI:1285178665
Name:PATH MEDICAL, LLC
Entity type:Organization
Organization Name:PATH MEDICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNARDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-218-2164
Mailing Address - Street 1:2304 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1422
Mailing Address - Country:US
Mailing Address - Phone:754-218-2164
Mailing Address - Fax:
Practice Address - Street 1:2001 PALM BEACH LAKES BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6513
Practice Address - Country:US
Practice Address - Phone:561-240-6584
Practice Address - Fax:561-437-4142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATH MEDICAL CENTER HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-05
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center