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General NPI Number Information
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NPI Number | 1659490985
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Entity Type | Organization
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Legal Business Name | NEUROSCIENCE CENTER OF BOCA RATON INC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 3848 FAU BLVD SUITE 205
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City | BOCA RATON
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State | FL
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Zip | 33431-6437
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Country | US
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Telephone | 561-392-8533
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Fax |
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Provider Business Mailing Address
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Address Line | 3848 FAU BLVD SUITE 205
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City | BOCA RATON
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State | FL
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Zip | 33431-6437
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Country | US
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Telephone | 561-392-8533
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD S. BAILYN
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Credential | M.D.
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Telephone | 561-392-8533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 31716
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License Number State | FL
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