Provider Demographics
NPI:1144597824
Name:UNIVERSAL DIALYSIS GROUP,INC.
Entity Type:Organization
Organization Name:UNIVERSAL DIALYSIS GROUP,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-659-7478
Mailing Address - Street 1:60 PARK PL
Mailing Address - Street 2:SUITE 601
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-5511
Mailing Address - Country:US
Mailing Address - Phone:973-353-0021
Mailing Address - Fax:
Practice Address - Street 1:290 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1559
Practice Address - Country:US
Practice Address - Phone:845-659-7478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment