Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MB050440 | NJ |
Y | 208600000X | Surgeon | MB050440 | NJ |
N | 2082S0105X | Plastic Hand Surgeon | MB050440 | NJ |
NPI | 1619155710 |
---|---|
Provider Name | Robert Agresti |
First Address | Verona, NJ 07044-2707 |
Second Address | Verona, NJ 07044-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2008 |
Last Update Date | 31/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E07284 | (02) | NJ |