Healthcare Provider Details

I. General information

NPI: 1558432070
Provider Name (Legal Business Name): JACINTH REID-ARTIST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 NW 136 AVE 1002
PEMBROKE PINES FL
33028-2586
US

IV. Provider business mailing address

2250 NW 136 AVE 1002
PEMBROKE PINES FL
33028-2586
US

V. Phone/Fax

Practice location:
  • Phone: 609-271-8223
  • Fax: 954-392-6046
Mailing address:
  • Phone: 609-271-8223
  • Fax: 954-392-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberMA064667
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: