=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770379679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEPHROSYNC HEALTH SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2025
-----------------------------------------------------
Last Update Date | 04/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6264 NW 45TH TER
-----------------------------------------------------
City | COCONUT CREEK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33073-1956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-245-6881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6264 NW 45TH TER
-----------------------------------------------------
City | COCONUT CREEK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33073-1956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-245-6881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. CLEMENT MICHAEL PARTAP JR.
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 954-591-4546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------