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General NPI Number Information
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NPI Number | 1558608018
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Entity Type | Organization
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Legal Business Name | SPIRITUAL PYSCHIATRY PC
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 2803 E COMMERCIAL BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4205
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Country | US
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Telephone | 347-782-7247
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Fax | 954-200-7814
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Provider Business Mailing Address
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Address Line | PO BOX 811523
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City | BOCA RATON
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State | FL
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Zip | 33481-1523
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Country | US
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Telephone | 347-782-7247
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Fax | 954-200-7814
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEONID ALTSHULER
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Credential | M.D.
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Telephone | 347-782-7247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME104094
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License Number State | FL
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