NPIMap

Organization Active NPI

Kidney Life, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • North Bergen, NJ
National Provider Identifier
1831458660
Registry record updated Mar 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
22532 Issued in NJ
Legal business name
KIDNEY LIFE, LLC
Practice address
1310 5TH St
North Bergen, NJ 07047-1710
Phone
(201) 770-9220
Fax
(201) 770-9225
NPI assigned
May 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2026

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 22532 NJ Primary

Addresses

Primary practice location

1310 5TH St
North Bergen, NJ 07047-1710

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0983519MedicaidNJ

Other names 1

  • Jersey City Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230513000101 NJ Part A Provider - End-Stage Renal Disease Facility (ESRD) 2769665207 Practice locations: North Bergen, NJ

Other NPIs with the same Medicare PAC ID 23

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 23

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Jersey City DialysisCCN 312545
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Apr 5, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
17

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0951539Jersey City Dialysis1310 5TH Street, North Bergen, NJ 07047Certificate of waiverSep 21, 2026

National Provider Directory

National Provider Directory
Tax ID family
Kidney Life LLC24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Member of 1

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

Locations

1310 5th St
North Bergen, NJ 07047
Phone (201) 770-9220

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1336953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772755200000",
    "number": "1831458660",
    "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": "1310 5TH ST",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070471710",
            "telephone_number": "201-770-9220",
            "fax_number": "201-770-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-14",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "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": "NJ",
            "license": "22532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0983519",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jersey City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jersey City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Bergen, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; 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.