Healthcare Provider Details

I. General information

NPI: 1225483142
Provider Name (Legal Business Name): SPINE CARE INSTITUTE OF MIAMI BEACH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ARTHUR GODFREY RD STE 200
MIAMI BEACH FL
33140-3627
US

IV. Provider business mailing address

300 ARTHUR GODFREY RD STE 200
MIAMI BEACH FL
33140-3627
US

V. Phone/Fax

Practice location:
  • Phone: 305-423-3939
  • Fax: 305-674-8836
Mailing address:
  • Phone: 305-423-3939
  • Fax: 305-674-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104491
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0051493
License Number StateFL

VIII. Authorized Official

Name: MR. DAN S COHEN
Title or Position: OWNER
Credential: M.D.
Phone: 305-423-3939