=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215063839
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT O SCHIFTAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 02/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1905 CLINT MOORE ROAD SUITE 308
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33496-2661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-981-8011
-----------------------------------------------------
Fax | 561-981-8013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4623 FOREST HILL BLVD SUITE 101
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33415-9120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-966-7194
-----------------------------------------------------
Fax | 561-966-7191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | ME48746
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------