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General NPI Number Information
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NPI Number | 1235130840
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Entity Type | Organization
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Legal Business Name | ISLAND REHABILITATIVE SERVICES CORP.
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 470 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3401
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Country | US
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Telephone | 718-987-5942
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Fax | 718-667-9708
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Provider Business Mailing Address
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Address Line | 97 NEW DORP LN
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2364
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Country | US
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Telephone | 718-448-5641
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Fax | 718-876-5969
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DOMINIC LICCIARDI
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Credential |
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Telephone | 718-987-5942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State | NY
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