Basic Information
| Provider Information | |||||||||
| NPI: | 1972630283 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER HEALTH SERVICES, INC. | ||||||||
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| OtherOrganizationName: | POLA TENENBAUM CENTER FOR RENAL CARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 430 BEACH 68TH ST | ||||||||
| Address2: | DIALYSIS UNIT | ||||||||
| City: | ARVERNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116921407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184740357 | ||||||||
| FaxNumber: | 7184741948 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 BEACH 68TH ST | ||||||||
| Address2: | DIALYSIS UNIT | ||||||||
| City: | ARVERNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116921407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184740357 | ||||||||
| FaxNumber: | 7184741948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIEGER | ||||||||
| AuthorizedOfficialFirstName: | HELEN | ||||||||
| AuthorizedOfficialMiddleName: | TENENBAUM | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7187968100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 7001287R | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.