Provider Demographics
NPI:1558432070
Name:REID-ARTIST, JACINTH (MD)
Entity Type:Individual
Prefix:DR
First Name:JACINTH
Middle Name:
Last Name:REID-ARTIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 NW 136 AVE
Mailing Address - Street 2:1002
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2586
Mailing Address - Country:US
Mailing Address - Phone:609-271-8223
Mailing Address - Fax:954-392-6046
Practice Address - Street 1:2250 NW 136 AVE
Practice Address - Street 2:1002
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2586
Practice Address - Country:US
Practice Address - Phone:609-271-8223
Practice Address - Fax:954-392-6046
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064667225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7269200Medicaid
NJ7269200Medicaid
NJ874196Medicare PIN