Provider Demographics
NPI:1740476209
Name:PHYSICIANS IN KIDNEY DISEASE & CELL THERAPIES, PA
Entity type:Organization
Organization Name:PHYSICIANS IN KIDNEY DISEASE & CELL THERAPIES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-412-0103
Mailing Address - Street 1:301 SUPOR BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1912
Mailing Address - Country:US
Mailing Address - Phone:973-412-0103
Mailing Address - Fax:973-412-0105
Practice Address - Street 1:301 SUPOR BLVD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1912
Practice Address - Country:US
Practice Address - Phone:973-412-0103
Practice Address - Fax:973-412-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52649207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6073603Medicaid
NJF38523Medicare UPIN
NJ051866Medicare PIN