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General NPI Number Information
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NPI Number | 1811186653
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Entity Type | Organization
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Legal Business Name | JEFFREY S GORODETSKY MD PA
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 433 E OCEAN BLVD
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City | STUART
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State | FL
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Zip | 34994-2573
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Country | US
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Telephone | 772-223-4504
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Fax | 772-223-5988
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Provider Business Mailing Address
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Address Line | 433 E OCEAN BLVD
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City | STUART
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State | FL
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Zip | 34994-2573
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Country | US
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Telephone | 772-223-4504
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Fax | 772-223-5988
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY S GORODETSKY
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Credential | MD
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Telephone | 772-223-4504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | ME0053894
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License Number State | FL
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