Provider Demographics
NPI:1699115584
Name:CENTER FOR ORTHOPEDIC AND SPINAL SURGERY LLC
Entity type:Organization
Organization Name:CENTER FOR ORTHOPEDIC AND SPINAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-845-7078
Mailing Address - Street 1:701 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE#201
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5215
Mailing Address - Country:US
Mailing Address - Phone:561-845-7078
Mailing Address - Fax:561-845-8030
Practice Address - Street 1:701 NORTHLAKE BLVD
Practice Address - Street 2:SUITE#201
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5215
Practice Address - Country:US
Practice Address - Phone:561-845-7078
Practice Address - Fax:561-845-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00073142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty