NPIMap

Organization Active NPI

Owens Dialysis LLC

Doing business as Lyndhurst Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Lyndhurst, NJ
National Provider Identifier
1366996555
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
OWENS DIALYSIS LLC
Doing business as
Lyndhurst Dialysis
Practice address
554-A New York Ave
Lyndhurst, NJ 07071-1532
Phone
(201) 933-4782
Fax
(201) 804-7545
NPI assigned
Aug 5, 2016
Last updated
Apr 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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

Authorized official

Name
Samuel Wey
Title
VP, Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

554-A New York Ave
Lyndhurst, NJ 07071-1532

Mailing address

5200 Virginia Way
L & C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
0626392MedicaidNJ

Other names 1

  • Lyndhurst Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160906000287 NJ Part A Provider - End-Stage Renal Disease Facility (ESRD) 4486940228 Practice locations: Lyndhurst, NJ

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Lyndhurst DialysisCCN 312670
Overall star rating
4.0 of 5
Ownership
Profit
Certified
May 3, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
19

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

540 New York Ave
Lyndhurst, NJ 07071
Phone (201) 933-4782

554 New York Ave
#A
Lyndhurst, NJ 07071
Phone (201) 933-4782

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1366996555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L & C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "554-A NEW YORK AVE",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070711532",
            "telephone_number": "201-933-4782",
            "fax_number": "201-804-7545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OWENS DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-05",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP, LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0626392",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lyndhurst Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lyndhurst Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lyndhurst, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.