Organization
NEPHROLOGY SERVICES MEDICAL GROUP OF NEW JERSEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN A. OTRAKJI M.D. (PRESIDENT)
(732) 888-9100
Entity
Organization
Contact information
Practice address
721 N BEERS ST, SUITE 1F, HOLMDEL, NJ 07733-1518
(732) 888-9100
(732) 888-5515
Mailing address
721 N BEERS ST, SUITE 1F, HOLMDEL, NJ 07733-1518
(732) 888-9100
(732) 888-5515
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
25MA04735600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6940803
—
NJ
Enumeration date
05/31/2006
Last updated
03/23/2011
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