Provider Demographics
NPI:1538253778
Name:SOUTH FLORIDA NEPHROLOGY ASSOCIATES P A
Entity type:Organization
Organization Name:SOUTH FLORIDA NEPHROLOGY ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:GERONEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-739-2511
Mailing Address - Street 1:2951 NW 49TH AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1600
Mailing Address - Country:US
Mailing Address - Phone:954-739-2511
Mailing Address - Fax:954-739-9239
Practice Address - Street 1:2951 NW 49TH AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1600
Practice Address - Country:US
Practice Address - Phone:954-739-2511
Practice Address - Fax:954-739-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036206207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63026Medicare UPIN
FLF24873Medicare UPIN
FLI15305Medicare UPIN
FLD88492Medicare UPIN