Healthcare Provider Details

I. General information

NPI: 1134647878
Provider Name (Legal Business Name): COORDINATED NEUROLOGIC SERVICES 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JFK DR STE 146
ATLANTIS FL
33462-6608
US

IV. Provider business mailing address

9960 NW 116TH WAY STE 13
MEDLEY FL
33178-1175
US

V. Phone/Fax

Practice location:
  • Phone: 561-570-2444
  • Fax: 561-209-2923
Mailing address:
  • Phone: 786-924-1311
  • Fax: 786-924-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JAMES N GOLDENBERG
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 561-570-2444