Healthcare Provider Details

I. General information

NPI: 1669403143
Provider Name (Legal Business Name): NEPHROLOGY HYPERTENSION RENAL TRANSPLANT & RENAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE LOWER LEVEL 1
AVENEL NJ
07001-1390
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE LOWER LEVEL 1
AVENEL NJ
07001-1390
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-5555
  • Fax: 732-750-5550
Mailing address:
  • Phone: 732-750-5555
  • Fax: 732-750-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. ALEXANDER M SWAN
Title or Position: OWNER
Credential: M.D
Phone: 732-750-5555