MEDICARE: BRONX RIVER NEPHRO-CARE 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	7000249R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063452563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX RIVER NEPHRO-CARE INC.

Provider Business Mailing Address
First Line	:	1616 BRONXDALE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-3302
Country	:	US
Telephone Number	:	718-430-9800
Fax Number	:	718-430-6854

Provider Business Practice Location Address
First Line	:	100 W KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-3903
Country	:	US
Telephone Number	:	718-579-0280
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. CORENE KORBA
Credential	:
Telephone Number	:	914-644-9276

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	12/22/2016

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