Provider Demographics
NPI:1366461527
Name:NEWARK RENAL CENTERS, LLC
Entity Type:Organization
Organization Name:NEWARK RENAL CENTERS, LLC
Other - Org Name:HILLSIDE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURRIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-474-7701
Mailing Address - Street 1:7061 CYPRESS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2243
Mailing Address - Country:US
Mailing Address - Phone:954-474-7701
Mailing Address - Fax:954-474-7702
Practice Address - Street 1:1529 N BROAD ST
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1603
Practice Address - Country:US
Practice Address - Phone:973-474-1199
Practice Address - Fax:973-474-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0121029Medicaid
NJ312587Medicare Oscar/Certification