Healthcare Provider Details

I. General information

NPI: 1750685111
Provider Name (Legal Business Name): EAST ATLANTIC SPECIALTY MANAGEMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LINTON BLVD STE 100
DELRAY BEACH FL
33445-6600
US

IV. Provider business mailing address

4600 LINTON BLVD SUITE 100
DELRAY BEACH FL
33445-6600
US

V. Phone/Fax

Practice location:
  • Phone: 561-791-1836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EUGENIO RODRIGUEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 561-381-9900