Healthcare Provider Details

I. General information

NPI: 1740476209
Provider Name (Legal Business Name): PHYSICIANS IN KIDNEY DISEASE & CELL THERAPIES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SUPOR BLVD
HARRISON NJ
07029-1912
US

IV. Provider business mailing address

301 SUPOR BLVD
HARRISON NJ
07029-1912
US

V. Phone/Fax

Practice location:
  • Phone: 973-412-0103
  • Fax: 973-412-0105
Mailing address:
  • Phone: 973-412-0103
  • Fax: 973-412-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMA52649
License Number StateNJ

VIII. Authorized Official

Name: DR. GARY S FRIEDMAN
Title or Position: MD
Credential: MD
Phone: 973-412-0103