Provider Demographics
NPI:1144349671
Name:MINKOFFSPORTSOPEDIC ASSOCIATES P.A.
Entity type:Organization
Organization Name:MINKOFFSPORTSOPEDIC ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-999-9349
Mailing Address - Street 1:9070 KIMBERLY BLVD STE 24
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2861
Mailing Address - Country:US
Mailing Address - Phone:561-999-9349
Mailing Address - Fax:561-999-9368
Practice Address - Street 1:9070 KIMBERLY BLVD STE 24
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2861
Practice Address - Country:US
Practice Address - Phone:561-999-9349
Practice Address - Fax:561-999-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079507204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA62794Medicare UPIN
FLK4161Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER