Healthcare Provider Details

I. General information

NPI: 1770118705
Provider Name (Legal Business Name): NEW REGENERATION ORTHOPEDICS OF FLORIDA, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20754 W DIXIE HWY UNIT 2C
MIAMI FL
33180-1146
US

IV. Provider business mailing address

2401 UNIVERSITY PKWY STE 104
SARASOTA FL
34243-2894
US

V. Phone/Fax

Practice location:
  • Phone: 786-855-4800
  • Fax: 941-256-7452
Mailing address:
  • Phone: 786-855-4800
  • Fax: 941-256-7452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JAMES D. LEIBER
Title or Position: OWNER/MEDICAL DOCTOR
Credential: DO
Phone: 786-855-4800