1578933461 NPI number — KIDNEY MEDICAL ASSOCIATES PLLC

Table of content: (NPI 1578933461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578933461 NPI number — KIDNEY MEDICAL ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY MEDICAL ASSOCIATES PLLC
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:
1578933461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 MARCONI ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10461-0379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-794-1200
Provider Business Mailing Address Fax Number:
718-794-1222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 MARCONI ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-0379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-794-1200
Provider Business Practice Location Address Fax Number:
718-794-1222
Provider Enumeration Date:
10/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SCARANO
Authorized Official First Name:
JO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
718-794-1200

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com