Healthcare Provider Details

I. General information

NPI: 1831132547
Provider Name (Legal Business Name): BAYONNE RENAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 - 436 BROADWAY
BAYONNE NJ
07002-3628
US

IV. Provider business mailing address

5200 VIRGINIA WAY L & C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 201-436-1664
  • Fax: 201-436-5133
Mailing address:
  • Phone: 615-341-6410
  • Fax: 888-662-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number22816
License Number StateNJ

VIII. Authorized Official

Name: SAMUEL T WEY
Title or Position: VP, LICENSURE AND CERTIFICATION
Credential:
Phone: 615-341-6691