Provider Demographics
NPI:1518934207
Name:THE NEPHROLOGY GROUP PA
Entity Type:Organization
Organization Name:THE NEPHROLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:GOLDBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-325-2103
Mailing Address - Street 1:111 NORTHFIELD AVENUE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4703
Mailing Address - Country:US
Mailing Address - Phone:973-325-2103
Mailing Address - Fax:973-325-2254
Practice Address - Street 1:111 NORTH FIELD AVENUE
Practice Address - Street 2:SUITE 311
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4703
Practice Address - Country:US
Practice Address - Phone:973-325-2103
Practice Address - Fax:973-325-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2650703Medicaid
NJ2650703Medicaid