MEDICARE: STEPHEN NEMEROFSKY M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1235410499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN NEMEROFSKY M.D., P.A.

Provider Business Mailing Address
First Line	:	1111 HYPOLUXO RD
Second Line	:	SUITE 107
City	:	LANTANA
State	:	FL
Zip	:	33462-4271
Country	:	US
Telephone Number	:	561-586-3400
Fax Number	:	561-585-0079

Provider Business Practice Location Address
First Line	:	1700 WATERFORD DR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-8043
Country	:	US
Telephone Number	:	772-257-6217
Fax Number	:	772-257-6219

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHEN LOUIS NEMEROFSKY
Credential	:	M.D.
Telephone Number	:	561-586-3400

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	09/01/2011

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