Healthcare Provider Details

I. General information

NPI: 1902907652
Provider Name (Legal Business Name): PERSONAL DIALYSIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 CAMBRIDGE ST
BRIGHTON MA
02135-2926
US

IV. Provider business mailing address

400 W CUMMINGS PARK SUITE 2250
WOBURN MA
01801-6519
US

V. Phone/Fax

Practice location:
  • Phone: 617-783-3800
  • Fax: 617-783-0255
Mailing address:
  • Phone: 781-932-8891
  • Fax: 617-783-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberEQZF
License Number StateMA

VIII. Authorized Official

Name: DR. MARTIN L. GELMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 781-932-8891