1528137072 NPI number — PREMIER RENAL CARE, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528137072 NPI number — PREMIER RENAL CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER RENAL CARE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528137072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7705 SHORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11209-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-715-8674
Provider Business Mailing Address Fax Number:
212-966-0068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 MOTT ST
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10013-5540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-966-0068
Provider Business Practice Location Address Fax Number:
212-966-0072
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MA
Authorized Official First Name:
CHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-715-8674

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  180042 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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