Provider Demographics
NPI:1548272974
Name:SOUTH PALM BEACH MEDICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:SOUTH PALM BEACH MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEOR
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SKOCZYLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-302-9445
Mailing Address - Street 1:22380 DORADO DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4962
Mailing Address - Country:US
Mailing Address - Phone:561-302-9445
Mailing Address - Fax:561-760-3999
Practice Address - Street 1:1130 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1333
Practice Address - Country:US
Practice Address - Phone:561-394-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93589314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0214Medicare ID - Type Unspecified