MEDICARE: BETH ISRAEL MEDICAL CENTER

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

General Provider Information

NPI Number	:	1265634356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETH ISRAEL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1555 3RD AVE
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10128-3107
Country	:	US
Telephone Number	:	212-870-9395
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 3RD AVE
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10128-3107
Country	:	US
Telephone Number	:	212-870-9395
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TONI JONES
Credential	:
Telephone Number	:	212-256-3027

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	08/22/2020

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