Provider Demographics
NPI:1871719369
Name:BOCA RATON PSYCHIATRIC GROUP, PA
Entity type:Organization
Organization Name:BOCA RATON PSYCHIATRIC GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:Z
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-368-8998
Mailing Address - Street 1:7100 WEST CAMINO REAL
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-368-8998
Mailing Address - Fax:561-392-9170
Practice Address - Street 1:7100 WEST CAMINO REAL
Practice Address - Street 2:SUITE 401
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-368-8998
Practice Address - Fax:561-392-9170
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOCA RATON PSYCHIATRIC GROUP, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77273Medicare ID - Type Unspecified