Organization Name: | LAWRENCE J BENTVENA DC PA |
NPI Number: | 1295041572 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAWWRENCE J BENTVENA (OWNER) |
Mailing Address: | 6252 S Congress Ave Suite J1 Lantana |
State: | FL US |
Postal Code: | 334622352 |
Phone Number: | 5614338500 |
Fax Number: | 5616416821 |
NPI Enumeration Date: | 08/25/2010 |
NPI Last Update Date: | 08/25/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QH0100X |
License Number: | CH 8760 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Health Service |
Taxonomy Definition: |