Provider Demographics
NPI:1043758790
Name:METROPOLITAN NEPHROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:METROPOLITAN NEPHROLOGY ASSOCIATES, PC
Other - Org Name:METRO VASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXIMENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, RT
Authorized Official - Phone:215-568-6822
Mailing Address - Street 1:235 N BROAD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1511
Mailing Address - Country:US
Mailing Address - Phone:215-568-6822
Mailing Address - Fax:215-568-6833
Practice Address - Street 1:235 N BROAD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-568-6822
Practice Address - Fax:215-568-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA22371501207RI0011X, 207RN0300X, 2085R0204X, 2086S0129X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty