Provider Demographics
NPI:1457353872
Name:DEMOS, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DEMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PERRINE RD
Mailing Address - Street 2:SUITE 324
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3627
Mailing Address - Country:US
Mailing Address - Phone:732-753-9890
Mailing Address - Fax:732-753-9893
Practice Address - Street 1:300 PERRINE RD
Practice Address - Street 2:SUITE 324
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3627
Practice Address - Country:US
Practice Address - Phone:732-753-9890
Practice Address - Fax:732-753-9893
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04896400207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0586307Medicaid
NJE53206Medicare UPIN