Organization
KIDNEY CENTER OF VINELAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEVERLY EDISS (GOVERNMENT BILLING SUPERVISOR)
(856) 575-4742
Entity
Organization
Contact information
Practice address
1318 S MAIN RD, VINELAND, NJ 08360-6516
(856) 575-4742
(856) 451-5269
Mailing address
333 IRVING AVE, BRIDGETON, NJ 08302-2123
(856) 575-4742
(856) 451-5269
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004090
—
NJ
Enumeration date
07/04/2006
Last updated
05/30/2008
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