=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194151381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRYSALIS INSTITUTE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2013
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8000 N FEDERAL HWY STE 110
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33487-1681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-394-2532
-----------------------------------------------------
Fax | 561-210-1371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3648 MYKONOS CT
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33487-1295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-789-9922
-----------------------------------------------------
Fax | 561-210-1371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREGORY MARSELLA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-394-2532
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------