Provider Demographics
NPI:1952847477
Name:DIALYZE DIRECT MO LLC
Entity Type:Organization
Organization Name:DIALYZE DIRECT MO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-806-9968
Mailing Address - Street 1:1575 50TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3769
Mailing Address - Country:US
Mailing Address - Phone:732-806-9990
Mailing Address - Fax:
Practice Address - Street 1:1918 INNERBELT BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5760
Practice Address - Country:US
Practice Address - Phone:732-806-9990
Practice Address - Fax:732-806-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-08
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment