Maryjo Agosta
Individual provider Active NPI Physician Assistant · Union, NJ
NPI 1083067722 · NPPES record last updated Jul 18, 2016
Key facts
- NPI
- 1083067722
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 25MP00403100 (NJ)
- Practice address
- 1000 Galloping Hill Rd
Union, NJ 07083-7989 - Phone
- (908) 522-6300
- NPI assigned
- Jul 18, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Medical Group of New Jersey
Practice addresses (Care Compare)
1286 Springfield Ave
New Providence, NJ 07974-2901
Phone (908) 402-3338
651 Willow Grove St
Hackettstown, NJ 07840-1799
Phone (908) 979-1621
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161018000111 | NJ | Practitioner - Physician Assistant | 1951699370 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MP00403100 | NJ | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25MP00403100 | NJ | Yes |
Addresses
Primary practice location
1000 Galloping Hill Rd
Union, NJ 07083-7989
Mailing address
30 Roosevelt Ave
Chatham, NJ 07928-2548
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All providers in Union, NJ · Physician Assistant in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.