Provider Demographics
NPI:1689613648
Name:CENTER FOR KIDNEY DISEASE AND HYPERTENSION, LLC
Entity Type:Organization
Organization Name:CENTER FOR KIDNEY DISEASE AND HYPERTENSION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:IRWIN-OBREGON
Authorized Official - Suffix:
Authorized Official - Credentials:DO FACOI
Authorized Official - Phone:856-374-4440
Mailing Address - Street 1:129 JOHNSON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1777
Mailing Address - Country:US
Mailing Address - Phone:856-374-4440
Mailing Address - Fax:
Practice Address - Street 1:129 JOHNSON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1777
Practice Address - Country:US
Practice Address - Phone:856-374-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty