Provider Demographics
NPI:1528508512
Name:PURE KINETICS
Entity type:Organization
Organization Name:PURE KINETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROTH
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-794-4500
Mailing Address - Street 1:683 E 34TH STREET
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07513
Mailing Address - Country:US
Mailing Address - Phone:973-345-1400
Mailing Address - Fax:973-345-1404
Practice Address - Street 1:683 E 34TH STREET
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07513
Practice Address - Country:US
Practice Address - Phone:201-794-4500
Practice Address - Fax:201-794-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies