MEDICARE: UNION CITY RENAL CENTER, 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	22515	NJ

General Provider Information

NPI Number	:	1972502151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION CITY RENAL CENTER, LLC

Provider Business Mailing Address
First Line	:	508 31ST ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3907
Country	:	US
Telephone Number	:	201-902-9382
Fax Number	:	201-902-0661

Provider Business Practice Location Address
First Line	:	508 31ST ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3907
Country	:	US
Telephone Number	:	201-902-9382
Fax Number	:	201-902-0661

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LORA ZWEIMAN
Credential	:
Telephone Number	:	914-644-9213

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/01/2008

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