Provider Demographics
NPI:1730375346
Name:SOUTH PALM ORTHOSPINE INSTITUTE
Entity type:Organization
Organization Name:SOUTH PALM ORTHOSPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:G
Authorized Official - Last Name:EIDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-742-5959
Mailing Address - Street 1:8198 JOG RD
Mailing Address - Street 2:#100
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2998
Mailing Address - Country:US
Mailing Address - Phone:561-742-5959
Mailing Address - Fax:561-734-2226
Practice Address - Street 1:8198 JOG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2998
Practice Address - Country:US
Practice Address - Phone:561-742-5959
Practice Address - Fax:561-734-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55593207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730375346OtherNPI
FL5981790002Medicare NSC