Provider Demographics
NPI:1740407923
Name:NEPHROLOGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:NEPHROLOGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN
Authorized Official - Phone:973-736-2212
Mailing Address - Street 1:83 HANOVER ROAD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1520
Mailing Address - Country:US
Mailing Address - Phone:973-736-2212
Mailing Address - Fax:973-736-2989
Practice Address - Street 1:83 HANOVER ROAD
Practice Address - Street 2:SUITE 290
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1520
Practice Address - Country:US
Practice Address - Phone:973-736-2212
Practice Address - Fax:973-736-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2625806Medicaid
NJ2625806Medicaid