Organization
PASCACK COMMUNITY SERVICES
Active
Organization
PASCACK COMMUNITY SERVICES
Active
Other names
lillian booth dialysis center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN SHANNON (BILLER)
(201) 664-1842
Entity
Organization
Contact information
Practice address
363 OLD HOOK RD, WESTWOOD, NJ 07675-3201
(201) 664-6649
(201) 664-5542
Mailing address
363 OLD HOOK RD, WESTWOOD, NJ 07675-3201
(201) 664-6649
(201) 664-5542
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
80137
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009552
EMPIRE
NY
05
—
01560030
—
NY
01
—
2020133
AETNA
NJ
05
—
6585701
—
NJ
01
—
91068
AMERICHOICE
NJ
01
—
H478876
OXFORD
NJ
01
—
IL00996
HEALTHNET
NJ
Enumeration date
08/24/2005
Last updated
08/22/2020
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