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General NPI Number Information
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NPI Number | 1134202740
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Entity Type | Organization
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Legal Business Name | PRESIDENTIAL SURGICENTER, INC.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 1501 PRESIDENTIAL WAY SUITE #9
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City | WEST PALM BEACH
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State | FL
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Zip | 33401
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Country | US
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Telephone | 561-689-7255
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Fax | 561-683-7342
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Provider Business Mailing Address
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Address Line | 1501 PRESIDENTIAL WAY, SUITE #9
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City | WEST PALM BEACH
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State | FL
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Zip | 33401
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Country | US
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Telephone | 561-689-7255
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Fax | 561-683-7342
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAY S. WALLSHEIN
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Credential | MD.
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Telephone | 561-689-7255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 921
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License Number State | FL
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