Healthcare Provider Details

I. General information

NPI: 1972509644
Provider Name (Legal Business Name): SURFSIDE PAIN CONTROL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 95TH ST STE 206
SURFSIDE FL
33154-2807
US

IV. Provider business mailing address

260 95TH ST STE 206
SURFSIDE FL
33154-2807
US

V. Phone/Fax

Practice location:
  • Phone: 305-861-0078
  • Fax: 305-993-3828
Mailing address:
  • Phone: 305-861-0078
  • Fax: 305-993-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME81951
License Number StateFL

VIII. Authorized Official

Name: MRS. VERA VASERSHTEYN
Title or Position: PRESIDENT
Credential: A.P
Phone: 305-861-0078