Healthcare Provider Details

I. General information

NPI: 1407064348
Provider Name (Legal Business Name): FALL RIVER NEPHROLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

1030 PRESIDENT AVE
FALL RIVER MA
02720-5923
US

V. Phone/Fax

Practice location:
  • Phone: 508-235-6427
  • Fax: 508-235-6654
Mailing address:
  • Phone: 508-235-6427
  • Fax: 508-235-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9763104
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: DR. JEFFREY D HOROWITZ
Title or Position: MEDICAL MANAGER
Credential: M.D.
Phone: 508-235-6427