Healthcare Provider Details

I. General information

NPI: 1821104084
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES OF SOUTH BROWARD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE SUITE 620
HOLLYWOOD FL
33021-5424
US

IV. Provider business mailing address

1150 N 35TH AVE SUITE 620
HOLLYWOOD FL
33021-5424
US

V. Phone/Fax

Practice location:
  • Phone: 954-989-9553
  • Fax: 954-989-9607
Mailing address:
  • Phone: 954-989-9553
  • Fax: 954-989-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES N REICH
Title or Position: PRESIDENT
Credential: MD
Phone: 954-989-9553