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NPI Code Detail

MEDICARE: DAUGHTERS OF JACOB DIALYSIS CENTER CORP

MEDICARE: DAUGHTERS OF JACOB DIALYSIS CENTER CORP
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/Center

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 : 1548489586
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAUGHTERS OF JACOB DIALYSIS CENTER CORP
Provider Business Mailing Address
First Line : 1160 TELLER AVE
Second Line :
City : BRONX
State : NY
Zip : 10456-4145
Country : US
Telephone Number : 718-293-1500
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 : 718-293-1500
Fax Number :
Authorized Official
Title or Position : BILLING MANAGER
Name : MS. COREY KORBA
Credential :
Telephone Number : 914-644-9276
Provider Enumeration Date : 04/25/2007
Last Update Date : 08/22/2020

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