Provider Demographics
NPI:1730351289
Name:FRESENIUS MEDICAL CARE COMPREHENSIVE CKD SE
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE COMPREHENSIVE CKD SE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-2668
Mailing Address - Street 1:920 WINTER ST
Mailing Address - Street 2:FMCNA CKD SERVICES 3W-16
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1521
Mailing Address - Country:US
Mailing Address - Phone:781-699-4160
Mailing Address - Fax:781-699-4046
Practice Address - Street 1:83 HANOVER RD.
Practice Address - Street 2:SUITE 290
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1508
Practice Address - Country:US
Practice Address - Phone:973-966-5200
Practice Address - Fax:973-966-0300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0189723Medicaid
NJ128124Medicare UPIN