Organization
BUCKHORN DIALYSIS LLC
Active
Other names
Irvington Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
468 CHANCELLOR AVE, STE WS-3, IRVINGTON, NJ 07111-4001
(973) 373-0294
(973) 371-1595
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0638200
—
NJ
Enumeration date
03/01/2018
Last updated
04/01/2024
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