Provider Demographics
NPI:1043389349
Name:HOLY NAME HOSPITAL REGIONAL DIALYSIS CENTER
Entity Type:Organization
Organization Name:HOLY NAME HOSPITAL REGIONAL DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, DIALYSIS CENTER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JULIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-833-3000
Mailing Address - Street 1:718 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4245
Mailing Address - Country:US
Mailing Address - Phone:201-833-3000
Mailing Address - Fax:201-833-4486
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-833-3000
Practice Address - Fax:201-833-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4135407Medicaid
NJ312302Medicare ID - Type Unspecified