| Organization Name: | SURFSIDE PAIN CONTROL CENTER |
| NPI Number: | 1972509644 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VERA VASERSHTEYN (PRESIDENT) |
| Mailing Address: | 260 95th St Ste 206 Surfside |
| State: | FL US |
| Postal Code: | 331542807 |
| Phone Number: | 3058610078 |
| Fax Number: | 3059933828 |
| NPI Enumeration Date: | 06/27/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | ME81951 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |