Healthcare Provider Details

I. General information

NPI: 1750687927
Provider Name (Legal Business Name): BROAD PAIN CARE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 02/09/2011
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

501 GLADES RD
BOCA RATON FL
33432-1419
US

V. Phone/Fax

Practice location:
  • Phone: 561-362-4400
  • Fax:
Mailing address:
  • Phone: 561-362-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW ASTROVE
Title or Position: OWNER
Credential: MD
Phone: 908-653-9399