=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194990333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CANCER CENTER OF SOUTH FLORIDA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2008
-----------------------------------------------------
Last Update Date | 06/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1630 S CONGRESS AVE STE 200
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461-2171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-253-3980
-----------------------------------------------------
Fax | 561-253-3985
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 160748
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32716-0748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-253-3980
-----------------------------------------------------
Fax | 561-253-3985
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER MEMBER
-----------------------------------------------------
Name | DR. ABRAHAM B SCHWARZBERG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-253-3980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0200X
-----------------------------------------------------
Taxonomy Name | Oncology Clinic/Center
-----------------------------------------------------
License Number | ME100528
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QX0200X
-----------------------------------------------------
Taxonomy Name | Oncology Clinic/Center
-----------------------------------------------------
License Number | ME100088
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------