Provider Demographics
NPI:1407064348
Name:FALL RIVER NEPHROLOGY, P.C.
Entity Type:Organization
Organization Name:FALL RIVER NEPHROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-235-6427
Mailing Address - Street 1:1030 PRESIDENT AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5923
Mailing Address - Country:US
Mailing Address - Phone:508-235-6427
Mailing Address - Fax:508-235-6654
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-235-6427
Practice Address - Fax:508-235-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9763104Medicaid
MA9763104Medicaid