Provider Demographics
NPI:1740485267
Name:IMBRIANO, MICHAEL ANGELO (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:IMBRIANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08272700207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0162850Medicaid
NJP00788983OtherRR MEDICARE
NJ124921ZC8AMedicare PIN
NJ124921UXWMedicare PIN
NJ0162850Medicaid
NJ124921ZC79Medicare PIN