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General NPI Number Information
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NPI Number | 1386069029
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Entity Type | Organization
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Legal Business Name | OMNI NEUROLOGICAL ORTHOPEDIC AND SPINE CENTER INC
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Dates
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Enumeration Date | 03/04/2014
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 817 S. UNIVERSITY DR SUITE 109
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City | PLANTATION
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State | FL
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Zip | 33324-3309
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Country | US
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Telephone | 954-279-2170
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Fax | 954-424-9533
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Provider Business Mailing Address
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Address Line | 817 S. UNIVERSITY DR SUITE 109
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City | PLANTATION
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State | FL
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Zip | 33324-3309
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Country | US
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Telephone | 954-279-2170
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Fax | 954-424-9533
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Authorized Official
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Title or Position | ACCOUNTS PAYABLE/MANAGER
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Name | MARISA S MERLO
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Credential |
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Telephone | 954-279-2170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | FL
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