Provider Demographics
NPI:1497704712
Name:REICH, JEROME S (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:S
Last Name:REICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:21550 BISCAYNE BLVD SUITE 133
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-792-0555
Mailing Address - Fax:305-792-0557
Practice Address - Street 1:1380 NE MIAMI GARDENS DRIVE
Practice Address - Street 2:#225
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179
Practice Address - Country:US
Practice Address - Phone:305-652-9652
Practice Address - Fax:305-652-7494
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2015-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME9336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370936100Medicaid
FLD59447Medicare UPIN
FL370936100Medicaid