Provider Demographics
NPI:1194943878
Name:NUTLEY KIDNEY CLINIC LLC
Entity type:Organization
Organization Name:NUTLEY 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:
Authorized Official - Phone:718-268-4933
Mailing Address - Street 1:10917 72ND RD
Mailing Address - Street 2:SUITE 6R
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 1:500 CORTLANDT ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3331
Practice Address - Country:US
Practice Address - Phone:973-450-7560
Practice Address - Fax:973-450-7568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ312601Medicare PIN