Healthcare Provider Details

I. General information

NPI: 1013258037
Provider Name (Legal Business Name): PHYSICIANS CHOICE DIALYSIS OF NORTHFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 SHORE RD
NORTHFIELD NJ
08225-2136
US

IV. Provider business mailing address

211 COMMERCE CT SUITE 104
POTTSTOWN PA
19464-3483
US

V. Phone/Fax

Practice location:
  • Phone: 610-495-8900
  • Fax: 610-495-8560
Mailing address:
  • Phone: 610-495-8900
  • Fax: 610-495-8560

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: RHONDA B PALUMBO
Title or Position: DIRECTOR
Credential:
Phone: 610-495-8900