Healthcare Provider Details

I. General information

NPI: 1972933745
Provider Name (Legal Business Name): PERINATAL SPECIALISTS OF THE PALM BEACHES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 SE PALM CT
STUART FL
34994-4914
US

IV. Provider business mailing address

2979 PGA BLVD SUITE 200
PALM BEACH GARDENS FL
33410-2911
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-9929
  • Fax: 772-288-9931
Mailing address:
  • Phone: 561-275-7604
  • Fax: 561-802-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME64730
License Number StateFL

VIII. Authorized Official

Name: JOHN BURIGO
Title or Position: PRESIDENT
Credential: MD
Phone: 561-275-7604