Healthcare Provider Details

I. General information

NPI: 1538198486
Provider Name (Legal Business Name): KIDNEY AND HYPERTENSION SPECIALISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAGNOLIA AVE SUITE A
BRIDGETON NJ
08302-1759
US

IV. Provider business mailing address

20 MAGNOLIA AVE SUITE A
BRIDGETON NJ
08302-1759
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-6002
  • Fax: 856-455-6106
Mailing address:
  • Phone: 856-455-6002
  • Fax: 856-455-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIS M. PRIORI
Title or Position: PRESIDENT
Credential: MD
Phone: 856-455-6002