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General NPI Number Information
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NPI Number | 1821028606
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Entity Type | Organization
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Legal Business Name | UNIVERSITY CANCER INSTITUTE LLC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 2240 W WOOLBRIGHT ROAD SUITE 415
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6367
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Country | US
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Telephone | 561-737-6556
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Fax | 561-737-2662
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Provider Business Mailing Address
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Address Line | 2240 W WOOLBRIGHT ROAD SUITE 415
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6367
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Country | US
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Telephone | 561-737-6556
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Fax | 561-737-2662
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. THOMAS MJ NIEDERMAN
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Credential | M.D.
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Telephone | 561-737-6556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME80006
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License Number State | FL
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