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General NPI Number Information
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NPI Number | 1609173061
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Entity Type | Organization
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Legal Business Name | NICUSOR IEREMIA MD PA
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Dates
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Enumeration Date | 02/22/2011
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Last Update Date | 02/22/2011
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Provider Practice Location Address
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Address Line | 7280 W PALMETTO PARK RD S103
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City | BOCA RATON
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State | FL
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Zip | 33433-3422
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Country | US
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Telephone | 561-395-4300
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Fax | 561-395-7180
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Provider Business Mailing Address
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Address Line | 7280 W PALMETTO PARK RD S103
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City | BOCA RATON
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State | FL
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Zip | 33433-3422
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Country | US
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Telephone | 561-395-4300
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Fax | 561-395-7180
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICUSOR IEREMIA
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Credential | M.D.
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Telephone | 561-395-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0061930
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License Number State | FL
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