Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MA0726100 | NJ |
Y | 111NI0900X | Internist | 25MA0726100 | NJ |
N | 207RA0401X | Internist - Addiction Medicine | XA9072240 | NJ |
NPI | 1255389813 |
---|---|
Provider Name | James V Agresti III |
First Address | Newark, NJ 07105-3612 |
Second Address | Nutley, NJ 07110-3820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 07/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0079588 | (05) | NJ |
I22896 | (02) | NJ |