1730504655 NPI number — NEW YORK MEDICAL CARE FOR NEPHROLOGY 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 1730504655 NPI number — NEW YORK MEDICAL CARE FOR NEPHROLOGY P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK MEDICAL CARE FOR NEPHROLOGY 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:
1730504655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8740 134TH ST
Provider Second Line Business Mailing Address:
RICHMOND HILL
Provider Business Mailing Address City Name:
RICHMOND HILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11418-2815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-666-1144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10120 LEFFERTS BLVD
Provider Second Line Business Practice Location Address:
RICHMOND HILL
Provider Business Practice Location Address City Name:
SOUTH RICHMOND HILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11419-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-666-1144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
AL-WAILI
Authorized Official First Name:
NOORI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
347-666-1144

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  269850 , 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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