Organization
EAST DELRAY MEDICAL P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE DEITSCH (OFFICE MANAGER)
(561) 302-6560
Entity
Organization
Contact information
Practice address
16 LAKE EDEN DR, BOYNTON BEACH, FL 33435-8667
(561) 302-6560
Mailing address
16 LAKE EDEN DR, BOYNTON BEACH, FL 33435-8667
(561) 302-6560
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME74637
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44314
PROVIDER NUMBER
FL
Enumeration date
06/07/2007
Last updated
09/16/2010
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