Provider Demographics
NPI:1578945598
Name:DE JESUS, EDDY J (MD)
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:J
Last Name:DE JESUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1650 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7606
Mailing Address - Country:US
Mailing Address - Phone:718-960-1234
Mailing Address - Fax:718-960-2055
Practice Address - Street 1:722 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7008
Practice Address - Country:US
Practice Address - Phone:954-345-4333
Practice Address - Fax:954-345-4334
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME143523207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology