Provider Demographics
NPI:1235183898
Name:THE CENTER FOR KIDNEYCARE, P.C.
Entity Type:Organization
Organization Name:THE CENTER FOR KIDNEYCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-222-1975
Mailing Address - Street 1:1261 ROUTE 38
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036
Mailing Address - Country:US
Mailing Address - Phone:856-222-1975
Mailing Address - Fax:856-222-0165
Practice Address - Street 1:1261 ROUTE 38
Practice Address - Street 2:SUITE A
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036
Practice Address - Country:US
Practice Address - Phone:856-222-1975
Practice Address - Fax:856-222-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4624807Medicaid
NJ4624807Medicaid