Provider Demographics
NPI:1265594659
Name:NEPHROLOGY GROUP OF NORTHEAST
Entity type:Organization
Organization Name:NEPHROLOGY GROUP OF NORTHEAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-737-2722
Mailing Address - Street 1:4131 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4326
Mailing Address - Country:US
Mailing Address - Phone:904-737-2722
Mailing Address - Fax:907-737-2723
Practice Address - Street 1:4131 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4326
Practice Address - Country:US
Practice Address - Phone:904-737-2722
Practice Address - Fax:907-737-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77773Medicare ID - Type Unspecified