Dialyze Direct Il LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

DIALYZE DIRECT IL LLC

Practice address

410 S Heinlein Dr
Shelbyville, IL 62565-7800

Phone

(732) 806-9990

NPI assigned

Sep 17, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joshua Rothenberg

Title

Coo

Phone

(732) 806-9990

Specialties & licenses 1

Addresses

Other names 1

• Dialyze Direct IL - Shelbyville Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568678400000",
    "number": "1124678529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3297 STATE ROUTE 66",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077532762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S HEINLEIN DR",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625657800",
            "telephone_number": "732-806-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYZE DIRECT IL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-17",
        "status": "A",
        "authorized_official_last_name": "ROTHENBERG",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "732-806-9990"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dialyze Direct IL - Shelbyville",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Shelbyville, IL
• Providers in Shelbyville, IL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.