Provider Demographics
NPI:1417910902
Name:DIALYSIS SERVICES OF NJ INC-MANAHAWKIN
Entity Type:Organization
Organization Name:DIALYSIS SERVICES OF NJ INC-MANAHAWKIN
Other - Org Name:U S RENAL CARE MANAHAWKIN DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:PO BOX 19119
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6601
Mailing Address - Country:US
Mailing Address - Phone:870-931-5400
Mailing Address - Fax:870-931-5418
Practice Address - Street 1:675 ROUTE 72 E
Practice Address - Street 2:SUITE 1006-B
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3501
Practice Address - Country:US
Practice Address - Phone:609-978-6723
Practice Address - Fax:609-978-6730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U S RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-07
Last Update Date:2018-06-21
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
NJ0000474000OtherAMERIHEALTH NJ
NJ60001769OtherKEYSTONE MERCY
NJ7078046OtherAETNA
NJ7881801OtherAMERICHOICE
NJ953402799OtherAETNA MEDICARE HMO
NJ2206019OtherAETNA US HEALTHCARE
NJ7881801Medicaid
NJ7278046OtherAETNA
NJA2019304OtherOXFORD HEALTH
NJ7278046OtherAETNA