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NPI Code Detail

MEDICARE: RIDGEWOOD DIALYSIS CENTER, INC

MEDICARE: RIDGEWOOD DIALYSIS CENTER, 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center7003241RNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1005333OTHERNYEMPIRE BCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467451229
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIDGEWOOD DIALYSIS CENTER, INC
Provider Business Mailing Address
First Line : 23-14 COLLEGE POINT BLVD
Second Line :
City : COLLEGE POINT
State : NY
Zip : 11356-2526
Country : US
Telephone Number : 718-366-1111
Fax Number : 718-821-2956
Provider Business Practice Location Address
First Line : 385 SENECA AVE
Second Line :
City : RIDGEWOOD
State : NY
Zip : 11385-1340
Country : US
Telephone Number : 718-366-1111
Fax Number : 718-821-2956
Authorized Official
Title or Position : PRESIDENT
Name : J. GANESH BHAT
Credential : MD
Telephone Number : 718-366-1111
Provider Enumeration Date : 07/14/2005
Last Update Date : 03/04/2015

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