Provider Demographics
NPI:1720064256
Name:REICH, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7593 W BOYNTON BEACH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6162
Mailing Address - Country:US
Mailing Address - Phone:561-966-7707
Mailing Address - Fax:888-316-2198
Practice Address - Street 1:5401 S CONGRESS AVE STE 212
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6635
Practice Address - Country:US
Practice Address - Phone:561-357-2040
Practice Address - Fax:561-357-2045
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236304207R00000X
FLME152183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ388AH2OtherEMPIRE BC/BS (MIDLAND PK)
NJ388AH1OtherEMPIRE BC/BS (RAMSEY)
NJ7900725OtherAETNA PPO #
NJP3648701OtherOXFORD #
NJ1104343OtherAETNA HMO #
NJ096101C7CMedicare PIN
NJ1104343OtherAETNA HMO #