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General NPI Number Information
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NPI Number | 1396460218
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD REGIONAL OPCO
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 3475 SHERIDAN ST STE 104
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3640
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Country | US
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Telephone | 631-495-5262
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 N ORANGE ST
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City | WILMINGTON
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State | DE
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Zip | 19801-1120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. FELIKS KOGAN
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Credential |
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Telephone | 917-288-4414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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