Provider Demographics
NPI:1073559480
Name:REINBERG, JAY E (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:REINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 AVENTURA BLVD
Mailing Address - Street 2:SUITE 247
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3118
Mailing Address - Country:US
Mailing Address - Phone:305-932-9880
Mailing Address - Fax:305-932-1035
Practice Address - Street 1:2845 AVENTURA BLVD
Practice Address - Street 2:SUITE 247
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3118
Practice Address - Country:US
Practice Address - Phone:305-932-9880
Practice Address - Fax:305-932-1035
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0065783OtherMEDICAL LICENSE
FL250658100Medicaid
FL31647UMedicare PIN
FL250658100Medicaid