Healthcare Provider Details

I. General information

NPI: 1821300344
Provider Name (Legal Business Name): NEUROLOGY OFFICES OF SOUTH FLORIDA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 CENTRAL PARK BLVD N SUITE 207
BOCA RATON FL
33428-2231
US

IV. Provider business mailing address

9970 CENTRAL PARK BLVD N SUITE 207
BOCA RATON FL
33428-2231
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-1027
  • Fax: 561-482-1028
Mailing address:
  • Phone: 561-482-1027
  • Fax: 561-482-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME90900
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME90900
License Number StateFL

VIII. Authorized Official

Name: DR. BRIAN ADAM COSTELL
Title or Position: NEUROLOGIST/CEO OWNER
Credential: MD
Phone: 561-482-1027