Organization
AQUARIUS PHYSICIANS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT SHATANOFF (GENERAL PARTNER)
(561) 790-4177
Entity
Organization
Contact information
Practice address
749 US HIGHWAY 1, SUITE 210, NORTH PALM BEACH, FL 33408-4400
(561) 790-4177
Mailing address
749 US HIGHWAY 1, SUITE 210, NORTH PALM BEACH, FL 33408-4400
(561) 790-4177
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L16000150039
STATE LICENSE NUMBER
FL
Enumeration date
08/18/2016
Last updated
08/18/2016
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