Healthcare Provider Details

I. General information

NPI: 1245264001
Provider Name (Legal Business Name): STEPHEN LOUIS NEMEROFSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 HYPOLUXO RD SUITE 107
LANTANA FL
33462-4271
US

IV. Provider business mailing address

1111 HYPOLUXO RD SUITE 107
LANTANA FL
33462-4271
US

V. Phone/Fax

Practice location:
  • Phone: 561-586-3400
  • Fax: 561-585-0079
Mailing address:
  • Phone: 561-586-3400
  • Fax: 561-585-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number19488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: