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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