Basic Information
| Provider Information | |||||||||
| NPI: | 1821480237 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLENGARIFF DIALYSIS CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 DOSORIS LN | ||||||||
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| City: | GLEN COVE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115421225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166761100 | ||||||||
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| Address1: | 141 DOSORIS LN | ||||||||
| Address2: | |||||||||
| City: | GLEN COVE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115421225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166761100 | ||||||||
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| ProviderEnumerationDate: | 02/21/2015 | ||||||||
| LastUpdateDate: | 02/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | AHUJA | ||||||||
| AuthorizedOfficialFirstName: | SANJAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER / MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5166761100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.