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NPI Code Detail

MEDICARE: NEW JERSEY KIDNEY CARE LLC

MEDICARE: NEW JERSEY KIDNEY CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194277392
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW JERSEY KIDNEY CARE LLC
Provider Business Mailing Address
First Line : 26 GREENVILLE AVE
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07305-2608
Country : US
Telephone Number : 201-333-8222
Fax Number : 201-333-0095
Provider Business Practice Location Address
First Line : 26 GREENVILLE AVE
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07305-2608
Country : US
Telephone Number : 201-333-8222
Fax Number : 201-333-0095
Authorized Official
Title or Position : PRESIDENT
Name : RYAN VALLE
Credential :
Telephone Number : 781-699-9362
Provider Enumeration Date : 11/04/2016
Last Update Date : 07/24/2024

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Directions to “NEW JERSEY KIDNEY CARE LLC ” Practice Location

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