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General NPI Number Information
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NPI Number | 1396290409
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Entity Type | Organization
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Legal Business Name | AQUARIUS PHYSICIANS GROUP
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 749 US HIGHWAY 1 SUITE 210
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City | NORTH PALM BEACH
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State | FL
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Zip | 33408-4400
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Country | US
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Telephone | 561-790-4177
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Fax |
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Provider Business Mailing Address
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Address Line | 749 US HIGHWAY 1 SUITE 210
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City | NORTH PALM BEACH
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State | FL
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Zip | 33408-4400
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Country | US
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Telephone | 561-790-4177
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | ROBERT SHATANOFF
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Credential |
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Telephone | 561-790-4177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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