Provider Demographics
NPI:1043468416
Name:JACKSONVILLE NEPHROLOGY PA
Entity type:Organization
Organization Name:JACKSONVILLE NEPHROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNJAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:904-260-9898
Mailing Address - Street 1:13241 BARTRAM PARK BLVD UNIT 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5236
Mailing Address - Country:US
Mailing Address - Phone:904-260-9898
Mailing Address - Fax:904-260-9891
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5236
Practice Address - Country:US
Practice Address - Phone:904-260-9898
Practice Address - Fax:904-260-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91566207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty