Healthcare Provider Details

I. General information

NPI: 1033136064
Provider Name (Legal Business Name): BROAD ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GLADES RD
BOCA RATON FL
33432-1419
US

IV. Provider business mailing address

DEPT 991 PO BOX 850001
ORLANDO FL
32885-0991
US

V. Phone/Fax

Practice location:
  • Phone: 561-362-4400
  • Fax: 561-362-4445
Mailing address:
  • Phone: 908-653-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW ASTROVE
Title or Position: PRACTICE MANAGER
Credential: MD
Phone: 561-362-4400