Healthcare Provider Details

I. General information

NPI: 1760020366
Provider Name (Legal Business Name): ERIC PETER REIGELSBERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 11/27/2023
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4657 MAIN ST
JUPITER FL
33458-5203
US

IV. Provider business mailing address

4035 SABAL LAKES RD
DELRAY BEACH FL
33445-1218
US

V. Phone/Fax

Practice location:
  • Phone: 305-480-5232
  • Fax: 561-799-3800
Mailing address:
  • Phone: 660-676-1544
  • Fax: 561-799-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberAL4436
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: