Provider Demographics
NPI:1144564063
Name:JERSEY DIALYSIS CENTERS, LLC
Entity Type:Organization
Organization Name:JERSEY DIALYSIS CENTERS, LLC
Other - Org Name:JERSEY DIALYSIS CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:PINELES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-518-2770
Mailing Address - Street 1:165 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6414
Mailing Address - Country:US
Mailing Address - Phone:973-618-5620
Mailing Address - Fax:973-226-5993
Practice Address - Street 1:165 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6414
Practice Address - Country:US
Practice Address - Phone:973-618-5620
Practice Address - Fax:973-226-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment