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NPI Code Detail

MEDICARE: SEA CREST ACQUISITION II, LLC

MEDICARE: SEA CREST ACQUISITION II, 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/Center1111NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1332763OTHERCCN

General Provider Information

NPI Number : 1598206641
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEA CREST ACQUISITION II, LLC
Provider Business Mailing Address
First Line : 3035 W 24TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-2114
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3035 W 24TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-2114
Country : US
Telephone Number : 516-422-7817
Fax Number :
Authorized Official
Title or Position : MANAGER / MEMBER
Name : PASQUALE DEBENEDICTIS
Credential :
Telephone Number : 516-422-7818
Provider Enumeration Date : 03/08/2017
Last Update Date : 06/12/2024

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