Provider Demographics
NPI:1962576025
Name:ROBERT J AGRESTI DO PA
Entity type:Organization
Organization Name:ROBERT J AGRESTI DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGRESTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:973-239-5580
Mailing Address - Street 1:1 MOUNT PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2707
Mailing Address - Country:US
Mailing Address - Phone:973-239-5580
Mailing Address - Fax:973-239-7082
Practice Address - Street 1:1 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2707
Practice Address - Country:US
Practice Address - Phone:973-239-5580
Practice Address - Fax:973-239-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB050440208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E07284Medicare UPIN
NJ002375Medicare ID - Type Unspecified