Provider Demographics
NPI:1215226584
Name:UNION COUNTY NEPHROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:UNION COUNTY NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:AGRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-272-0777
Mailing Address - Street 1:609 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1639
Mailing Address - Country:US
Mailing Address - Phone:908-272-0777
Mailing Address - Fax:908-272-6064
Practice Address - Street 1:609 BOULEVARD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1639
Practice Address - Country:US
Practice Address - Phone:908-272-0777
Practice Address - Fax:908-272-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04626400207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1529102Medicaid
C53454Medicare UPIN