Provider Demographics
NPI:1235139957
Name:ADAMIDIS, ANANEA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANANEA
Middle Name:
Last Name:ADAMIDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 UNION ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4303
Mailing Address - Country:US
Mailing Address - Phone:201-646-0414
Mailing Address - Fax:201-646-0365
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-833-3223
Practice Address - Fax:201-833-7090
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07932400207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069931Medicaid
NJP00309498Medicare PIN
NJI38730Medicare UPIN