Organization
KIDNEY LIFE, LLC
Active
Other names
New Brunswick Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
303 GEORGE ST, STE G-8, NEW BRUNSWICK, NJ 08901-2020
(732) 937-4791
(732) 937-4795
Mailing address
5200 VIRGINIA WAY, L & C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
24476
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0966398
—
NJ
Enumeration date
10/06/2011
Last updated
05/01/2024
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