Healthcare Provider Details

I. General information

NPI: 1629231246
Provider Name (Legal Business Name): NEURO ORTHO RAD MONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 MEDICAL PARK BLVD SUITE 101
WELLINGTON FL
33414-3164
US

IV. Provider business mailing address

1447 MEDICAL PARK BLVD SUITE 101
WELLINGTON FL
33414-3164
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-0120
  • Fax: 561-800-1074
Mailing address:
  • Phone: 561-844-0120
  • Fax: 561-800-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. AMOS O DARE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 561-844-0120