Organization
PHYSICIANS DIALYSIS SOMERVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY J BOOTH (CEO)
(305) 651-3261
Entity
Organization
Contact information
Practice address
1 ROUTE 206, NORTH, SOMERVILLE, NJ 08876
(908) 450-0396
Mailing address
19559 NE 10TH AVE, NORTH MIAMI BEACH, FL 33179-3501
(305) 651-3261
(305) 651-2961
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
23433
NJ
Other
Enumeration date
11/04/2016
Last updated
06/22/2017
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