Provider Demographics
NPI:1255338455
Name:HAMILTON PARK RENAL DIALYSIS CENTER, INC.
Entity type:Organization
Organization Name:HAMILTON PARK RENAL DIALYSIS CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLEVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-516-8564
Mailing Address - Street 1:328 9TH ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1502
Mailing Address - Country:US
Mailing Address - Phone:201-516-8564
Mailing Address - Fax:201-516-8586
Practice Address - Street 1:328 9TH ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1502
Practice Address - Country:US
Practice Address - Phone:201-516-8564
Practice Address - Fax:201-516-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23196261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0055492Medicaid
NJ0055492Medicaid
NJ312580Medicare Oscar/Certification