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NPI Code Detail

MEDICARE: JERSEY DIALYSIS CENTERS, LLC

MEDICARE: JERSEY DIALYSIS CENTERS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1144564063
Entity Type Code : Organization
Provider Name (Legal Business Name) : JERSEY DIALYSIS CENTERS, LLC
Provider Business Mailing Address
First Line : 165 FAIRFIELD AVE
Second Line :
City : WEST CALDWELL
State : NJ
Zip : 07006-6414
Country : US
Telephone Number : 973-618-5620
Fax Number : 973-226-5993
Provider Business Practice Location Address
First Line : 165 FAIRFIELD AVE
Second Line :
City : WEST CALDWELL
State : NJ
Zip : 07006-6414
Country : US
Telephone Number : 973-618-5620
Fax Number : 973-226-5993
Authorized Official
Title or Position : PRESIDENT
Name : MR. RICHARD I PINELES
Credential :
Telephone Number : 201-518-2770
Provider Enumeration Date : 11/15/2012
Last Update Date : 11/15/2012

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