Healthcare Provider Details

I. General information

NPI: 1962576025
Provider Name (Legal Business Name): ROBERT J AGRESTI DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/14/2008
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 TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMB050440
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberMB050440
License Number StateNJ

VIII. Authorized Official

Name: DR. ROBERT J AGRESTI JR.
Title or Position: PRES
Credential: DO
Phone: 973-239-5580