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General NPI Number Information
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NPI Number | 1063860724
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Entity Type | Organization
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Legal Business Name | BELLEVILLE KIDNEY CLINIC, LLC
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 500 CORTLANDT ST
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City | BELLEVILLE
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State | NJ
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Zip | 07109-3331
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Country | US
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Telephone | 718-268-7347
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Fax | 718-575-3375
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Provider Business Mailing Address
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Address Line | 500 CORTLANDT ST
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City | BELLEVILLE
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State | NJ
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Zip | 07109-3331
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Country | US
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Telephone | 718-268-7347
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Fax | 718-575-3375
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHRISTOPHER COLLINS
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Credential | RN, BSHCA
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Telephone | 973-450-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State | NJ
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