MEDICARE: SHINING STAR DIALYSIS INC

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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	22882	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598799439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINING STAR DIALYSIS INC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-341-6410
Fax Number	:	888-662-8259

Provider Business Practice Location Address
First Line	:	525 JACK MARTIN BLVD
Second Line	:	STE 200
City	:	BRICK
State	:	NJ
Zip	:	08724-7737
Country	:	US
Telephone Number	:	732-836-9669
Fax Number	:	732-836-9709

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JOHN D WINSTEL
Credential	:
Telephone Number	:	253-733-4501

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/12/2021

Similar Medicare Providers

1316627748 — JULIA MARIE VALKOS PA-C
Practice Location Address:

525 JACK MARTIN BLVD STE 340
BRICK, NJ
08724-7737

Practice Phone: 732-836-1500
Practice Fax: 732-746-3170

1356330773 — VIRGILIO MANGONON M.D.
Practice Location Address:

525 JACK MARTIN BLVD , SUITE 300
BRICK, NJ
08724-7737

Practice Phone: 732-840-0067
Practice Fax:

1184607657 — MRS. DEBORAH ANN MILLER APN
Practice Location Address:

525 JACK MARTIN BLVD
BRICK, NJ
08724-7737

Practice Phone: 732-840-1020
Practice Fax:

1962507251 — DR. ASSIF ROZOVSKY MD
Practice Location Address:

525 JACK MARTIN BLVD , SUITE 300
BRICK, NJ
08724-7737

Practice Phone: 732-840-0067
Practice Fax: 732-840-3169

1659469005 — DR. PACIFICO AGUILA MAGAHIS JR. M.D.
Practice Location Address:

525 JACK MARTIN BLVD , SUITE 301
BRICK, NJ
08724-7737

Practice Phone: 732-840-0067
Practice Fax: 732-840-3169

1336298629 — COASTAL GASTROENTEROLOGY ASSOCIATES, P.A.
Practice Location Address:

525 JACK MARTIN BLVD , SUITE 300
BRICK, NJ
08724-7737

Practice Phone: 732-840-0067
Practice Fax:

Directions to “SHINING STAR DIALYSIS INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.