=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801658620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPEDIC AND SPINE CARE OF SOUTH FLORIDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2024
-----------------------------------------------------
Last Update Date | 04/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 MEADOWS RD STE 103
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486-2346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-768-4672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4855 W HILLSBORO BLVD STE B8
-----------------------------------------------------
City | COCONUT CREEK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33073-4356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-443-3507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSHUA ROTHENBERG
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 786-443-3507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081S0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------