Provider Demographics
NPI:1629564653
Name:DIALYSIS CENTER OF MOUNTAINSIDE LLC
Entity Type:Organization
Organization Name:DIALYSIS CENTER OF MOUNTAINSIDE LLC
Other - Org Name:DIALYSIS CENTER OF EAST ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:20 SUSSEX AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-4228
Mailing Address - Country:US
Mailing Address - Phone:973-266-1093
Mailing Address - Fax:973-266-1094
Practice Address - Street 1:20 SUSSEX AVENUE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-4228
Practice Address - Country:US
Practice Address - Phone:973-266-1093
Practice Address - Fax:973-266-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment