MEDICARE: ISLAND NEPHROLOGY SERVICES, PC

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	207R00000X	Internal Medicine Physician		NY
2	207RN0300X	Nephrology Physician		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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598753253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND NEPHROLOGY SERVICES, PC

Provider Business Mailing Address
First Line	:	97 NEW DORP LN STE A
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2364
Country	:	US
Telephone Number	:	718-876-6220
Fax Number	:	718-876-5969

Provider Business Practice Location Address
First Line	:	470 SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3401
Country	:	US
Telephone Number	:	718-987-5940
Fax Number	:	718-667-9708

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MARGARET ALVAREZ
Credential	:
Telephone Number	:	718-876-6220

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	06/19/2025

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