MEDICARE: ISLAND REHABILITATIVE SERVICES/B'KLYN

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		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	:	1790779114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND REHABILITATIVE SERVICES/B'KLYN

Provider Business Mailing Address
First Line	:	2031-10 FOREST AVE
Second Line	:	ISLAND REHABILITATIVE SERVICES
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1796
Country	:	US
Telephone Number	:	718-448-5641
Fax Number	:	718-448-6117

Provider Business Practice Location Address
First Line	:	5918-5924 13TH AVE
Second Line	:	ISLAND REHABILITATIVE SERVICES/B'KLYN
City	:	BROOKLYN
State	:	NY
Zip	:	11219
Country	:	US
Telephone Number	:	718-437-1594
Fax Number	:	718-437-5092

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DOMINIC LICCIARDI
Credential	:
Telephone Number	:	718-437-1594

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/21/2022

Similar Medicare Providers

1215322144 — JOHN EDWARD BOWEN JR. MD
Practice Location Address:

4802 10TH AVE , MAIMONIDES MEDICAL CENTER
BROOKLYN, NY
11219

Practice Phone: 718-283-8000
Practice Fax:

1518803154 — HIVA AFSHARIAN M.D.
Practice Location Address:

MAIMONIDES MEDICAL CENTER , 4802 10TH AVENUE
BROOKLYN, NY
11219

Practice Phone: 718-283-6000
Practice Fax:

1669968269 — MS. OREL SHUKER MD
Practice Location Address:

4802 10TH AVE
BROOKLYN, NY
11219-2916

Practice Phone: 718-283-3000
Practice Fax:

1396681458 — HONEY DAVRONOVA RN
Practice Location Address:

1401 55TH ST APT 3F
BROOKLYN, NY
11219-4241

Practice Phone: 347-499-4548
Practice Fax:

1497691513 — JENNA VENEZIANO
Practice Location Address:

4802 10TH AVE
BROOKLYN, NY
11219-2916

Practice Phone: 718-283-6000
Practice Fax:

1891633624 — SAVANNAH H DZIADZIO
Practice Location Address:

4802 10TH AVE
BROOKLYN, NY
11219-2916

Practice Phone: 718-283-6879
Practice Fax:

1316887102 — SABZON NP IN FAMILY HEALTH P.C.
Practice Location Address:

1200 51ST ST UNIT 190401
BROOKLYN, NY
11219-7619

Practice Phone: 347-361-5995
Practice Fax: 929-241-0053

Directions to “ISLAND REHABILITATIVE SERVICES/B'KLYN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.