1881686608 NPI number — COASTAL NEPHROLOGY & HYPERTENSION CENTER PA

Table of content: (NPI 1881686608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881686608 NPI number — COASTAL NEPHROLOGY & HYPERTENSION CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL NEPHROLOGY & HYPERTENSION CENTER PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881686608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
641 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-2791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-253-8121
Provider Business Mailing Address Fax Number:
561-253-8021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
641 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-2791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-253-8121
Provider Business Practice Location Address Fax Number:
561-253-8021
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RABIEI, MD
Authorized Official First Name:
ABBAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-253-8121

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  ME84437 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3766903 . This is a "AETNA NON HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11127 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2087096 . This is a "FIRST HEALTH CCN NETWORK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 264835 . This is a "AMERIGROUP INS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7239688 . This is a "AETNA BLUE BELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3354249 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 263877100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5885 . This is a "AMERICAS HEALTH CHOICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9308574 . This is a "PHCS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: H67857 . This is a "VISTA HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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