Provider Demographics
NPI:1538116660
Name:PAGNANI-BRAGA-KIMMEL UROLOGIC ASSOC, P.A.
Entity Type:Organization
Organization Name:PAGNANI-BRAGA-KIMMEL UROLOGIC ASSOC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-653-4343
Mailing Address - Street 1:222 NEW ROAD BUILDING 700
Mailing Address - Street 2:CENTRAL PARK EAST
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221
Mailing Address - Country:UM
Mailing Address - Phone:609-653-4343
Mailing Address - Fax:609-653-4176
Practice Address - Street 1:222 NEW ROAD BUILDING 700
Practice Address - Street 2:CENTRAL PARK EAST
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:UM
Practice Address - Phone:609-653-4343
Practice Address - Fax:609-653-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ419644Medicare ID - Type UnspecifiedGROUP ID NUMBER
NJ3218007Medicaid