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General NPI Number Information
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NPI Number | 1144787243
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Entity Type | Organization
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Legal Business Name | NOVA ORTHO AND SPINE, PLLC
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 1903 S 25TH ST STE 103
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City | FORT PIERCE
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State | FL
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Zip | 34947-4740
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Country | US
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Telephone | 772-529-4573
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Fax | 772-410-4062
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Provider Business Mailing Address
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Address Line | 1903 S 25TH ST STE 103
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City | FORT PIERCE
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State | FL
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Zip | 34947-4740
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Country | US
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Telephone | 772-529-4573
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Fax | 772-410-4062
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARC D BRODSKY
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Credential | MD
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Telephone | 772-260-7023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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