Healthcare Provider Details
I. General information
NPI: 1134535925
Provider Name (Legal Business Name): PB DOCTORS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/01/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
141 NW 20TH STREET SUITE F-6
BOCA RATON FL
33431-7966
US
IV. Provider business mailing address
141 NW 20TH STREET SUITE F-6
BOCA RATON FL
33431-7966
US
V. Phone/Fax
- Phone: 561-212-0380
- Fax:
- Phone: 561-210-4994
- Fax: 954-905-4988
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0805X |
| Taxonomy | Geriatric Psychiatry Physician |
| License Number | ME83014 |
| License Number State | FL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 291U00000X |
| Taxonomy | Clinical Medical Laboratory |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RH0003X |
| Taxonomy | Hematology & Oncology Physician |
| License Number | 112386 |
| License Number State | NY |
VIII. Authorized Official
Name:
LEE
SCOTT
STEIN
Title or Position: MANAGING MEMBER
Credential:
Phone: 561-929-9263