MEDICARE: AVALON MEDICAL & REHABILITATION CENTER LLC

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1780158774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVALON MEDICAL & REHABILITATION CENTER LLC

Provider Business Mailing Address
First Line	:	3601 W COMMERCIAL BLVD STE 18
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3320
Country	:	US
Telephone Number	:	954-526-4777
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 W COMMERCIAL BLVD STE 18
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3320
Country	:	US
Telephone Number	:	954-526-4777
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROMAN ZAYDMAN
Credential	:
Telephone Number	:	954-526-4777

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	07/13/2020

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