Healthcare Provider Details

I. General information

NPI: 1215928981
Provider Name (Legal Business Name): REPLACEMENT ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 86TH ST 3RD FLOOR
NEW YORK NY
10028-3003
US

IV. Provider business mailing address

97 NEW DORP LN
STATEN ISLAND NY
10306-2364
US

V. Phone/Fax

Practice location:
  • Phone: 212-794-2850
  • Fax: 212-794-2187
Mailing address:
  • Phone: 718-448-5641
  • Fax: 718-876-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number7002180R
License Number StateNY

VIII. Authorized Official

Name: MR. DOMINIC LICCIARDI
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-987-5942