| Organization Name: | NOVA SOUTHEASTERN UNIVERSITY, INC. |
| NPI Number: | 1720126584 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT OLLER (CEO/CLINICAL OPERATIONS) |
| Mailing Address: | 3301 College Ave University Center Room 1433 Ft. Lauderdale |
| State: | FL US |
| Postal Code: | 333147721 |
| Phone Number: | 9542625590 |
| Fax Number: | 9542625570 |
| NPI Enumeration Date: | 02/02/2007 |
| NPI Last Update Date: | 06/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |