Provider Demographics
NPI:1851403927
Name:SOUTH MOUNTAIN NEPHROLOGY, LLC
Entity Type:Organization
Organization Name:SOUTH MOUNTAIN NEPHROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-450-8999
Mailing Address - Street 1:5 FRANKLIN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3532
Mailing Address - Country:US
Mailing Address - Phone:973-450-8999
Mailing Address - Fax:
Practice Address - Street 1:5 FRANKLIN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3532
Practice Address - Country:US
Practice Address - Phone:973-450-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062557207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100081Medicaid
NJG00972Medicare UPIN
NM089929Medicare ID - Type Unspecified