Provider Demographics
NPI:1134107691
Name:SOUTH PALM BEACH NEPHROLOGY, PA
Entity type:Organization
Organization Name:SOUTH PALM BEACH NEPHROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-965-7228
Mailing Address - Street 1:5503 S CONGRESS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6625
Mailing Address - Country:US
Mailing Address - Phone:561-965-7228
Mailing Address - Fax:561-965-0120
Practice Address - Street 1:5503 S CONGRESS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6625
Practice Address - Country:US
Practice Address - Phone:561-965-7228
Practice Address - Fax:561-965-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1003897810OtherNPI
LA1528059177OtherNPI
FL1811978950OtherNPI
FL1063403889OtherNPI
FL1508847088OtherNPI
FL1568443232OtherNPI
FL1538321021OtherNPI