MEDICARE: NEPHROLOGY FOUNDATION OF BKLYN

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	7001249R	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	:	1497745590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPHROLOGY FOUNDATION OF BKLYN

Provider Business Mailing Address
First Line	:	342 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4902
Country	:	US
Telephone Number	:	718-857-3000
Fax Number	:	718-857-6403

Provider Business Practice Location Address
First Line	:	342 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4902
Country	:	US
Telephone Number	:	718-857-3000
Fax Number	:	718-857-6403

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ALLEN I HERMAN
Credential	:
Telephone Number	:	718-857-3000

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	06/27/2008

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