Healthcare Provider Details

I. General information

NPI: 1467943787
Provider Name (Legal Business Name): CENTER FOR BONE & JOINT SURGERY OF THE PALM BEACHES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date: 07/25/2018
Reactivation Date: 08/17/2018

III. Provider practice location address

582 NW UNIVERSITY BLVD STE 100
PORT ST LUCIE FL
34986-2264
US

IV. Provider business mailing address

10131 FOREST HILL BLVD STE 230
WELLINGTON FL
33414-6109
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-6600
  • Fax: 561-753-3328
Mailing address:
  • Phone: 561-798-6600
  • Fax: 561-753-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: HARVEY MONTIJO
Title or Position: PARTNER
Credential: MD
Phone: 561-798-6600