Provider Demographics
NPI:1386665578
Name:RENAL GROUP OF CENTRAL NEW JERSEY
Entity Type:Organization
Organization Name:RENAL GROUP OF CENTRAL NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-246-9348
Mailing Address - Street 1:1350 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3341
Mailing Address - Country:US
Mailing Address - Phone:732-246-2626
Mailing Address - Fax:732-249-5480
Practice Address - Street 1:1350 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3341
Practice Address - Country:US
Practice Address - Phone:732-246-2626
Practice Address - Fax:732-249-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ707116Medicare ID - Type Unspecified