Healthcare Provider Details

I. General information

NPI: 1952352429
Provider Name (Legal Business Name): BOCA RATON OUTPATIENT LASER CENTER PATHOLOGY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 LINTON BLVD STE 250
DELRAY BEACH FL
33484-6528
US

IV. Provider business mailing address

PO BOX 8868
JUPITER FL
33468-8868
US

V. Phone/Fax

Practice location:
  • Phone: 561-748-4056
  • Fax:
Mailing address:
  • Phone: 561-748-4055
  • Fax: 561-748-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT COHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 561-748-4055