Healthcare Provider Details

I. General information

NPI: 1124066030
Provider Name (Legal Business Name): CENTER FOR PAIN MANAGEMENT AND ORTHOPAEDIC REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CYPRESS CREEK RD SUITE 203
FT LAUDERDALE FL
33334-3522
US

IV. Provider business mailing address

800 E CYPRESS CREEK RD SUITE 203
FT LAUDERDALE FL
33334-3522
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-5556
  • Fax: 954-772-6254
Mailing address:
  • Phone: 954-772-5556
  • Fax: 954-772-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS 6794
License Number StateFL

VIII. Authorized Official

Name: STEPHEN COSENTINO
Title or Position: OWNER
Credential: D.O.
Phone: 954-772-5556