Provider Demographics
NPI:1205921194
Name:RENAL MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:RENAL MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:O
Authorized Official - Last Name:BADDOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-731-3800
Mailing Address - Street 1:48 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:732-547-8050
Mailing Address - Fax:
Practice Address - Street 1:745 NORTHFIELD AVE
Practice Address - Street 2:SUITE 1 LOWER WEST LEVEL
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-731-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA70836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072088Medicare ID - Type Unspecified