Healthcare Provider Details

I. General information

NPI: 1538514666
Provider Name (Legal Business Name): TRI STATE NEPHROLOGISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ROUTE 45 STE 101
SALEM NJ
08079-2000
US

IV. Provider business mailing address

5 ROUTE 45 STE 101
SALEM NJ
08079-2000
US

V. Phone/Fax

Practice location:
  • Phone: 856-887-3005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD KASAMA
Title or Position: DOCTOR
Credential: M.D.
Phone: 856-887-3005