MEDICARE: KIDNEYLIFE FOUNDATION 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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1417157892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEYLIFE FOUNDATION INC

Provider Business Mailing Address
First Line	:	42 FIRE ISLAND AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-3502
Country	:	US
Telephone Number	:	631-219-0301
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 FIRE ISLAND AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-3502
Country	:	US
Telephone Number	:	631-219-0301
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER AND CHIEF EXECUTIVE OFFICER
Name	:	MR. GARET HIL
Credential	:
Telephone Number	:	631-219-0301

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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