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NPI Code Detail

MEDICARE: SURFSIDE PAIN CONTROL CENTER

MEDICARE: SURFSIDE PAIN CONTROL CENTER
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
1207QA0505XAdult Medicine PhysicianME81951FL

General Provider Information

NPI Number : 1972509644
Entity Type Code : Organization
Provider Name (Legal Business Name) : SURFSIDE PAIN CONTROL CENTER
Provider Business Mailing Address
First Line : 260 95TH ST
Second Line : STE 206
City : SURFSIDE
State : FL
Zip : 33154-2807
Country : US
Telephone Number : 305-861-0078
Fax Number : 305-993-3828
Provider Business Practice Location Address
First Line : 260 95TH ST
Second Line : STE 206
City : SURFSIDE
State : FL
Zip : 33154-2807
Country : US
Telephone Number : 305-861-0078
Fax Number : 305-993-3828
Authorized Official
Title or Position : PRESIDENT
Name : MRS. VERA VASERSHTEYN
Credential : A.P
Telephone Number : 305-861-0078
Provider Enumeration Date : 06/27/2005
Last Update Date : 08/22/2020

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Directions to “SURFSIDE PAIN CONTROL CENTER ” Practice Location

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