Healthcare Provider Details

I. General information

NPI: 1750805529
Provider Name (Legal Business Name): INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 DONALD ROSS RD
PALM BEACH GARDENS FL
33418-6783
US

IV. Provider business mailing address

PO BOX 744069, DEPT 50020
ATLANTA GA
30384-4069
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-2115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GILBERT DROZDOW
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371