Healthcare Provider Details

I. General information

NPI: 1144349671
Provider Name (Legal Business Name): MINKOFFSPORTSOPEDIC ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 KIMBERLY BLVD STE 24
BOCA RATON FL
33434-2861
US

IV. Provider business mailing address

9070 KIMBERLY BLVD STE 24
BOCA RATON FL
33434-2861
US

V. Phone/Fax

Practice location:
  • Phone: 561-999-9349
  • Fax: 561-999-9368
Mailing address:
  • Phone: 561-999-9349
  • Fax: 561-999-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberME0079507
License Number StateFL

VIII. Authorized Official

Name: JEFFREY MINKOFF
Title or Position: PRESIDENT
Credential: MD
Phone: 561-999-9349