Provider Demographics
NPI:1841210432
Name:EAST COAST NEPHROLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:EAST COAST NEPHROLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSCELYN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-672-4001
Mailing Address - Street 1:P.O. BOX 731268
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-1268
Mailing Address - Country:US
Mailing Address - Phone:386-672-4001
Mailing Address - Fax:386-672-4006
Practice Address - Street 1:335 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:ORMOND BRACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-672-4001
Practice Address - Fax:386-672-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063880207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378275100Medicaid
FLK4100Medicare ID - Type Unspecified
FL378275100Medicaid