Provider Demographics
NPI:1760020366
Name:REIGELSBERGER, ERIC PETER
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:PETER
Last Name:REIGELSBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 SABAL LAKES RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1218
Mailing Address - Country:US
Mailing Address - Phone:660-676-1544
Mailing Address - Fax:561-799-3800
Practice Address - Street 1:4657 MAIN ST
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5203
Practice Address - Country:US
Practice Address - Phone:305-480-5232
Practice Address - Fax:561-799-3800
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL44362083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000009019OtherBOC NUMBER