Provider Demographics
NPI:1245988955
Name:PALM BEACH REGIONAL OPCO LLC
Entity type:Organization
Organization Name:PALM BEACH REGIONAL OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIKS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-288-4414
Mailing Address - Street 1:505 PARK AVE STE 1700
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1106
Mailing Address - Country:US
Mailing Address - Phone:212-220-9922
Mailing Address - Fax:
Practice Address - Street 1:11030 RCA CENTER DR STE 3001
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4276
Practice Address - Country:US
Practice Address - Phone:212-220-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical