Healthcare Provider Details

I. General information

NPI: 1699114074
Provider Name (Legal Business Name): THE BRAIN AND SPINE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HARVARD CIR SUITE 104
WEST PALM BEACH FL
33409-1979
US

IV. Provider business mailing address

5 HARVARD CIR SUITE 104
WEST PALM BEACH FL
33409-1979
US

V. Phone/Fax

Practice location:
  • Phone: 561-603-6652
  • Fax: 888-563-9455
Mailing address:
  • Phone: 561-603-6652
  • Fax: 888-563-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME88243
License Number StateFL

VIII. Authorized Official

Name: DR. YONAS ZEGEYE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 561-603-6652