Provider Demographics
NPI:1912226051
Name:NORMAN VILLAGE KIDNEY CLINIC LLC
Entity Type:Organization
Organization Name:NORMAN VILLAGE KIDNEY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SARVA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:718-268-4933
Mailing Address - Street 1:10917 72ND RD
Mailing Address - Street 2:SUITE 6-R
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5336
Mailing Address - Country:US
Mailing Address - Phone:718-268-4933
Mailing Address - Fax:718-575-3375
Practice Address - Street 1:515 N ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4010
Practice Address - Country:US
Practice Address - Phone:973-674-1918
Practice Address - Fax:973-403-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment