KIDNEY LIFE LLC NPI 1295070811

NPI Information

  • NPI: 1295070811
  • Provider Name: KIDNEY LIFE, LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • :
  • CLIA Number: 31D2061762
  • Address: 375 MOUNT PLEASANT AVE
    STE 340
    WEST ORANGE, NJ
    ZIP 07052
  • Phone: (973) 243-7069

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NPI Details

KIDNEY LIFE, LLC is an end-stage renal disease (esrd) treatment clinic center in West Orange, NJ. KIDNEY LIFE, LLC NPI is 1295070811. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

375 MOUNT PLEASANT AVE
STE 340
WEST ORANGE, NJ
ZIP 07052-750
Phone: (973) 243-7069
Fax: (973) 731-1348

The provider's authorized official is Samuel Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 31D2061762 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/7/2012 and was last updated on 3/11/2025.

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
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

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
10968676MEDICAIDNEW 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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