Healthcare Provider Details

I. General information

NPI: 1548272974
Provider Name (Legal Business Name): SOUTH PALM BEACH MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 NW 15TH ST
BOCA RATON FL
33486-1333
US

IV. Provider business mailing address

22380 DORADO DR
BOCA RATON FL
33433-4962
US

V. Phone/Fax

Practice location:
  • Phone: 561-394-6282
  • Fax:
Mailing address:
  • Phone: 561-302-9445
  • Fax: 561-760-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberME93589
License Number StateFL

VIII. Authorized Official

Name: DR. LEOR JOSEPH SKOCZYLAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-302-9445