Provider Demographics
NPI:1538817010
Name:NEPHROGENX
Entity type:Organization
Organization Name:NEPHROGENX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PARTAP
Authorized Official - Suffix:JR
Authorized Official - Credentials:NP
Authorized Official - Phone:954-591-4546
Mailing Address - Street 1:1200 N FEDERAL HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-2813
Mailing Address - Country:US
Mailing Address - Phone:954-591-4546
Mailing Address - Fax:
Practice Address - Street 1:4101 NW 4TH ST STE 411
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2836
Practice Address - Country:US
Practice Address - Phone:954-591-4546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty