Healthcare Provider Details

I. General information

NPI: 1619155710
Provider Name (Legal Business Name): ROBERT AGRESTI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MOUNT PROSPECT AVE
VERONA NJ
07044-2707
US

IV. Provider business mailing address

1 MOUNT PROSPECT AVE
VERONA NJ
07044-2707
US

V. Phone/Fax

Practice location:
  • Phone: 973-239-5580
  • Fax: 973-239-7082
Mailing address:
  • Phone: 973-239-5580
  • Fax: 973-239-7082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMB050440
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberMB050440
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: