Healthcare Provider Details

I. General information

NPI: 1366461527
Provider Name (Legal Business Name): NEWARK RENAL CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 N BROAD ST
HILLSIDE NJ
07205-1603
US

IV. Provider business mailing address

7061 CYPRESS RD SUITE 104
PLANTATION FL
33317-2243
US

V. Phone/Fax

Practice location:
  • Phone: 973-474-1199
  • Fax: 973-474-1198
Mailing address:
  • Phone: 954-474-7701
  • Fax: 954-474-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. VICKI L BURRIER
Title or Position: DIRECTOR
Credential: R.N.
Phone: 954-474-7701