Provider Demographics
NPI:1871375816
Name:PRIME ORTHOPEDICS & REGENERATIVE CENTER LLC
Entity type:Organization
Organization Name:PRIME ORTHOPEDICS & REGENERATIVE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-254-1738
Mailing Address - Street 1:9835 LAKE WORTH RD STE 16-355
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2300
Mailing Address - Country:US
Mailing Address - Phone:561-459-4637
Mailing Address - Fax:561-810-1677
Practice Address - Street 1:6274 LINTON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6508
Practice Address - Country:US
Practice Address - Phone:561-495-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty