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General NPI Number Information
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NPI Number | 1275979700
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Entity Type | Organization
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Legal Business Name | PAIN DX SOLUTIONS OF FLORIDA, LLC
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Dates
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Enumeration Date | 05/10/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 24945 US HIGHWAY 19 N
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City | CLEARWATER
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State | FL
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Zip | 33763-3927
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Country | US
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Telephone | 201-620-8396
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Fax |
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Provider Business Mailing Address
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Address Line | 24945 US HIGHWAY 19 N
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City | CLEARWATER
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State | FL
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Zip | 33763-3927
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Country | US
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Telephone | 201-620-8396
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DAVID WOLSTEIN
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Credential | MD
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Telephone | 201-620-8396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME17577
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License Number State | FL
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