Healthcare Provider Details

I. General information

NPI: 1265981799
Provider Name (Legal Business Name): SOMA MEDICAL CENTER, PA #4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 FOREST HILL BLVD SUITE 101
WEST PALM BEACH FL
33406-6063
US

IV. Provider business mailing address

1840 FOREST HILL BLVD SUITE 101
WEST PALM BEACH FL
33406-6063
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-1181
  • Fax: 561-964-1196
Mailing address:
  • Phone: 561-964-1181
  • Fax: 561-964-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME108898
License Number StateFL

VIII. Authorized Official

Name: LINA NIEMCZYK
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-964-1181