=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699880229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERINATAL AND GYNECOLOGIC SPECIALISTS OF THE PALM BEACHES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 07/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 NORTHPOINT PKWY SUITE 200
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-1901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-655-3331
-----------------------------------------------------
Fax | 561-655-3744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2979 PGA BLVD SUITE 200
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-2911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-275-7604
-----------------------------------------------------
Fax | 561-802-5385
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | JOHN A BURIGO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-655-3331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------