Organization
KIDNEY LIFE, LLC
Active
Other names
Parkside Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
580 FRELINGHUYSEN AVE, NEWARK, NJ 07114-1361
(973) 733-9450
(973) 733-9455
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
—
0966436
—
NJ
Enumeration date
05/14/2012
Last updated
08/22/2025
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