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NPI Code Detail

MEDICARE: DIALYZE DIRECT GA, LLC

MEDICARE: DIALYZE DIRECT GA, 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 : 1447027651
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIALYZE DIRECT GA, LLC
Provider Business Mailing Address
First Line : 3297 STATE ROUTE 66
Second Line :
City : NEPTUNE
State : NJ
Zip : 07753-2762
Country : US
Telephone Number : 732-806-9990
Fax Number :
Provider Business Practice Location Address
First Line : 5151 BROOK HOLLOW PKWY
Second Line :
City : NORCROSS
State : GA
Zip : 30071-3664
Country : US
Telephone Number : 732-806-9990
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JOSHUA ROTHENBERG
Credential :
Telephone Number : 732-806-9990
Provider Enumeration Date : 12/07/2023
Last Update Date : 12/07/2023

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