Organization
BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY JOSEPH WIERZBICKI M.D. (CEO)
(386) 304-0111
Entity
Organization
Contact information
Practice address
1211 DUNLAWTON AVE, PORT ORANGE, FL 32127-2913
(386) 304-0111
Mailing address
1211 DUNLAWTON AVE, PORT ORANGE, FL 32127-2913
(386) 304-0111
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME80334
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130022355
MEDICARE RAILROAD
FL
05
—
259058100
—
FL
Enumeration date
03/12/2013
Last updated
03/15/2013
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