Provider Demographics
NPI:1053521427
Name:NORTH BROWARD REHABILITATION ASSOCIATES, INC.
Entity type:Organization
Organization Name:NORTH BROWARD REHABILITATION ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-941-5355
Mailing Address - Street 1:1 W SAMPLE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3547
Mailing Address - Country:US
Mailing Address - Phone:954-941-5355
Mailing Address - Fax:954-941-5675
Practice Address - Street 1:1 W SAMPLE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-941-5355
Practice Address - Fax:954-941-5675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60132208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053956200Medicaid
FL1396880043OtherNPI JEFFREY SAMUELS MD
FL12284ZMedicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE
FL1396880043OtherNPI JEFFREY SAMUELS MD
FL33240Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER