Provider Demographics
NPI:1720016041
Name:BSD NEPHROLOGY AND HYPERTENSION PA
Entity Type:Organization
Organization Name:BSD NEPHROLOGY AND HYPERTENSION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-646-0110
Mailing Address - Street 1:360 ESSEX ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8566
Mailing Address - Country:US
Mailing Address - Phone:201-646-0110
Mailing Address - Fax:201-646-0219
Practice Address - Street 1:160 OVERLOOK AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:HACKENSACK
Practice Address - State:NY
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-646-0110
Practice Address - Fax:201-646-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
093393Medicare ID - Type Unspecified