Healthcare Provider Details

I. General information

NPI: 1891927299
Provider Name (Legal Business Name): PHYSICIANS DIAGNOSTIC & REHABILITATION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 N STATE ROAD 7 SUITE 9
COCONUT CREEK FL
33073-4378
US

IV. Provider business mailing address

4651 N STATE ROAD 7 SUITE 9
COCONUT CREEK FL
33073-4378
US

V. Phone/Fax

Practice location:
  • Phone: 954-753-4248
  • Fax: 954-255-7990
Mailing address:
  • Phone: 954-753-4248
  • Fax: 954-255-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME8599
License Number StateFL

VIII. Authorized Official

Name: HOWARD NEWMAN
Title or Position: PRESIDENT
Credential:
Phone: 954-753-4248