Provider Demographics
NPI:1407183940
Name:ST. JOSEPH'S DIALYSIS , LLC
Entity Type:Organization
Organization Name:ST. JOSEPH'S DIALYSIS , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-754-2925
Mailing Address - Street 1:57 WILLOWBROOK BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7045
Mailing Address - Country:US
Mailing Address - Phone:973-754-4092
Mailing Address - Fax:973-754-4049
Practice Address - Street 1:57 WILLOWBROOK BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7045
Practice Address - Country:US
Practice Address - Phone:973-754-4092
Practice Address - Fax:973-754-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment