# NORTHEAST KIDNEY CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023889565
- **Authorized official:** ANKIT SHAH MD (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (732) 458-5854

## Contact information

- **Practice address:** 210 JACK MARTIN BLVD STE D1, BRICK, NJ 08724-7771
- **Practice address phone:** (732) 458-5854
- **Mailing address:** 210 JACK MARTIN BLVD STE D1, BRICK, NJ 08724-7771
- **Mailing address phone:** (732) 458-5854

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RN0300X | Nephrology Physician | — | NULL | — |
| 207RN0300X | Nephrology Physician | — | — | — |

## Other

- **Enumeration date:** 01/12/2024
- **Last updated:** 11/18/2024