Provider Demographics
NPI:1588808000
Name:NEPHROLOGY CONSULTANTS OF NJ, LLC.
Entity Type:Organization
Organization Name:NEPHROLOGY CONSULTANTS OF NJ, LLC.
Other - Org Name:NEPHROLOGY CONSULTANTS OF NJ, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IMBRIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-212-0051
Mailing Address - Street 1:1050 GEORGE ST
Mailing Address - Street 2:APT: 6G
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1012
Mailing Address - Country:US
Mailing Address - Phone:917-848-2318
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:19 HOLLY ST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2158
Practice Address - Country:US
Practice Address - Phone:908-272-4711
Practice Address - Fax:732-212-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08272700207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0162850Medicaid
NJ155381Medicare PIN