Healthcare Provider Details

I. General information

NPI: 1295785939
Provider Name (Legal Business Name): INNOVATIVE HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6345
US

IV. Provider business mailing address

729 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6345
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-5044
  • Fax: 954-786-8502
Mailing address:
  • Phone: 954-943-5044
  • Fax: 954-786-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT A. SILVERSTEIN
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 954-943-5044