Provider Demographics
NPI:1225028251
Name:THE RENAL CARE CLINIC, P.C.
Entity Type:Organization
Organization Name:THE RENAL CARE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:LAVANYA
Authorized Official - Last Name:SODAGUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-579-5009
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828
Mailing Address - Country:US
Mailing Address - Phone:973-579-5009
Mailing Address - Fax:973-579-3009
Practice Address - Street 1:67 HIGH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1705
Practice Address - Country:US
Practice Address - Phone:973-579-5009
Practice Address - Fax:973-579-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
096851Medicare PIN