Healthcare Provider Details

I. General information

NPI: 1346052842
Provider Name (Legal Business Name): TRITON MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W SAMPLE RD STE 404
DEERFIELD BEACH FL
33064
US

IV. Provider business mailing address

2001 W SAMPLE RD STE 404
DEERFIELD BEACH FL
33064
US

V. Phone/Fax

Practice location:
  • Phone: 954-773-8313
  • Fax:
Mailing address:
  • Phone: 954-773-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH COHEN
Title or Position: PARTNER
Credential:
Phone: 954-773-8313