Healthcare Provider Details

I. General information

NPI: 1144422486
Provider Name (Legal Business Name): HALLANDALE BEACH ORTHOPEDICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E HALLANDALE BEACH BLVD STE 700
HALLANDALE BEACH FL
33009-4641
US

IV. Provider business mailing address

1250 E HALLANDALE BEACH BLVD STE 700
HALLANDALE BEACH FL
33009-4641
US

V. Phone/Fax

Practice location:
  • Phone: 954-456-3757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberOS4493
License Number StateFL

VIII. Authorized Official

Name: HARRY COOPER
Title or Position: PRESIDENT
Credential: D.O
Phone: 954-456-3757