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NPI Code Detail

MEDICARE: FREEDOM CENTER OF KEW GARDENS, LLC

MEDICARE: FREEDOM CENTER OF KEW GARDENS, LLC
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1306595343
Entity Type Code : Organization
Provider Name (Legal Business Name) : FREEDOM CENTER OF KEW GARDENS, LLC
Provider Business Mailing Address
First Line : 12046 QUEENS BLVD
Second Line :
City : KEW GARDENS
State : NY
Zip : 11415-1204
Country : US
Telephone Number : 781-699-9000
Fax Number :
Provider Business Practice Location Address
First Line : 12046 QUEENS BLVD
Second Line :
City : KEW GARDENS
State : NY
Zip : 11415-1204
Country : US
Telephone Number : 781-699-9000
Fax Number :
Authorized Official
Title or Position : SENIOR VICE PRESIDENT
Name : BARRY BLANTON
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 03/18/2022
Last Update Date : 03/18/2022

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Directions to “FREEDOM CENTER OF KEW GARDENS, LLC ” Practice Location

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