Healthcare Provider Details

I. General information

NPI: 1386665578
Provider Name (Legal Business Name): RENAL GROUP OF CENTRAL NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HAMILTON ST
SOMERSET NJ
08873-3341
US

IV. Provider business mailing address

1350 HAMILTON ST
SOMERSET NJ
08873-3341
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-2626
  • Fax: 732-249-5480
Mailing address:
  • Phone: 732-246-2626
  • Fax: 732-249-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA46077
License Number StateNJ

VIII. Authorized Official

Name: TRINA GARCIA
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 732-246-9348