NORTHERN NEW JERSEY DIALYSIS LLC NPI 1124040019

NPI Information

NPI: 1124040019
Provider Name: NORTHERN NEW JERSEY DIALYSIS, LLC
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Doing Business As: ENGLEWOOD DIALYSIS CENTER
CLIA Number: 31D0962648
Address: 75 W FOREST AVE
ENGLEWOOD, NJ
ZIP 07631
Phone: (201) 503-1401

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NPI Details

NORTHERN NEW JERSEY DIALYSIS, LLC is an end-stage renal disease (esrd) treatment clinic center in Englewood, NJ. NORTHERN NEW JERSEY DIALYSIS, LLC NPI is 1124040019. The provider is registered as an organization entity type.
The provider Is Doing Business As Englewood Dialysis Center.

The provider's business location address is:

75 W FOREST AVE
ENGLEWOOD, NJ
ZIP 07631-000
Phone: (201) 503-1401
Fax: (201) 503-1406

The provider's authorized official is Barry L. Blanton .
The authorized official title is Vice President and has the following contact phone number (781) 699-9000.

The CLIA number assigned to this NPI record is 31D0962648 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/23/2006 and was last updated on 2/5/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	22236	NEW JERSEY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8228604	MEDICAID	NEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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