Organization
BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC
Active
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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