Provider Demographics
NPI:1538198486
Name:KIDNEY AND HYPERTENSION SPECIALISTS, P.A.
Entity type:Organization
Organization Name:KIDNEY AND HYPERTENSION SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRIORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-455-6002
Mailing Address - Street 1:20 MAGNOLIA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1759
Mailing Address - Country:US
Mailing Address - Phone:856-455-6002
Mailing Address - Fax:856-455-6106
Practice Address - Street 1:20 MAGNOLIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1759
Practice Address - Country:US
Practice Address - Phone:856-455-6002
Practice Address - Fax:856-455-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7786603Medicaid
91000472600OtherAMERICHOICE
1155117OtherHORIZON NJ HEALTH
NJ0000K04795OtherHEALTHNET
NJCH2537OtherRAILROAD MEDICARE-PALMETTO
0415761001OtherAMERIHEALTH
91000472600OtherAMERICHOICE