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General NPI Number Information
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NPI Number | 1407210669
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Entity Type | Organization
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Legal Business Name | EAST BOCA RATON PHYSICIANS GROUP, LLC
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 2234 N FEDERAL HWY SUITE 321
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City | BOCA RATON
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State | FL
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Zip | 33431-7710
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Country | US
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Telephone | 561-279-5221
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Fax |
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Provider Business Mailing Address
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Address Line | 2234 N FEDERAL HWY SUITE 321
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City | BOCA RATON
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State | FL
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Zip | 33431-7710
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Country | US
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Telephone | 561-279-5221
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACOB FRYDMAN
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Credential | BA
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Telephone | 561-279-5221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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