Provider Demographics
NPI:1598387318
Name:NEPHROGEN INC.
Entity Type:Organization
Organization Name:NEPHROGEN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAXIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-799-8358
Mailing Address - Street 1:39 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217-3809
Mailing Address - Country:US
Mailing Address - Phone:978-799-8358
Mailing Address - Fax:
Practice Address - Street 1:39 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217-3809
Practice Address - Country:US
Practice Address - Phone:978-799-8358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory