| Doctor Name: | DR. SERGEI DATNY |
| NPI Number: | 1912027889 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME36562 |
| Business Practice Address: | 1 W Camino Real Suite #218 Boca Raton, FL - 334325966 |
| Business Phone Number: | 5613471764 |
| Business Fax Number: | 5613471769 |
| Mailing Address: | 1 W Camino Real, Suite #218 BOCA RATON |
| State: | FL |
| Postal Code: | 334325966 |
| Phone Number: | 5613471764 |
| Fax Number: | 5613471769 |
| NPI Enumeration Date: | 04/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME36562 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |