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NPI Code Detail

MEDICARE: NEWTOWN DIALYSIS CENTER, INC

MEDICARE: NEWTOWN DIALYSIS CENTER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/CenterNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245502764
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEWTOWN DIALYSIS CENTER, INC
Provider Business Mailing Address
First Line : 23-14 COLLEGE POINT BLVD
Second Line :
City : COLLEGE POINT
State : NY
Zip : 11356-2526
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1160 TELLER AVE
Second Line :
City : BRONX
State : NY
Zip : 10456-4145
Country : US
Telephone Number : 718-483-7440
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : J3 GANESH BHAT
Credential : MD
Telephone Number : 718-366-1111
Provider Enumeration Date : 01/30/2012
Last Update Date : 03/04/2015

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