MEDICARE: WOODMERE DIALYSIS,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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

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	:	1750308748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODMERE DIALYSIS,LLC

Provider Business Mailing Address
First Line	:	121 FRANKLIN PL
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1218
Country	:	US
Telephone Number	:	516-374-9300
Fax Number	:	516-374-1786

Provider Business Practice Location Address
First Line	:	121 FRANKLIN PL
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1218
Country	:	US
Telephone Number	:	516-374-9300
Fax Number	:	516-374-1786

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BENT PHILIPSON
Credential	:
Telephone Number	:	516-374-9300

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	10/12/2007

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