MEDICARE: KIDNEY CARE ASSOCIATES, PLLC

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	207RN0300X	Nephrology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2348482	OTHER	NY	AETNA US HEALTHCARE-HMO
2	7921147	OTHER	NY	AETNA US HEALTHCARE-PPO

General Provider Information

NPI Number	:	1487637070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY CARE ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	2035 RALPH AVE
Second Line	:	SUITE #B5
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5300
Country	:	US
Telephone Number	:	718-209-4100
Fax Number	:	718-209-0715

Provider Business Practice Location Address
First Line	:	2035 RALPH AVE
Second Line	:	SUITE #B5
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5300
Country	:	US
Telephone Number	:	718-209-4100
Fax Number	:	718-209-0715

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WARREN B. SHAPIRO
Credential	:	MD
Telephone Number	:	718-209-4100

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	08/22/2020

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