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General NPI Number Information
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NPI Number | 1942512447
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PAIN MANAGEMENT CLINIC INC
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 3267 DAVIE BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312
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Country | US
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Telephone | 954-584-7009
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Fax | 954-584-7209
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Provider Business Mailing Address
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Address Line | 3267 DAVIE BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312
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Country | US
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Telephone | 954-584-7009
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Fax | 954-584-7209
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EREZ COHEN
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Credential |
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Telephone | 954-584-7009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS4663
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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