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General NPI Number Information
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NPI Number | 1417157892
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Entity Type | Organization
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Legal Business Name | KIDNEYLIFE FOUNDATION INC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 42 FIRE ISLAND AVE
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City | BABYLON
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State | NY
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Zip | 11702-3502
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Country | US
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Telephone | 631-219-0301
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Fax |
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Provider Business Mailing Address
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Address Line | 42 FIRE ISLAND AVE
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City | BABYLON
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State | NY
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Zip | 11702-3502
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Country | US
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Telephone | 631-219-0301
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND CHIEF EXECUTIVE OFFICER
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Name | MR. GARET HIL
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Credential |
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Telephone | 631-219-0301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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