Healthcare Provider Details

I. General information

NPI: 1598678443
Provider Name (Legal Business Name): FORGE SPINE AND INJURY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 SW 72ND AVE STE 309
MIAMI FL
33155-5550
US

IV. Provider business mailing address

4960 SW 72ND AVE STE 309
MIAMI FL
33155-5550
US

V. Phone/Fax

Practice location:
  • Phone: 786-947-6068
  • Fax: 786-590-1401
Mailing address:
  • Phone: 786-947-6068
  • Fax: 786-590-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN NIEVES
Title or Position: OWNER
Credential: MD
Phone: 786-351-5704