Provider Demographics
NPI:1144866252
Name:CITADEL RENAL CENTER LLC
Entity type:Organization
Organization Name:CITADEL RENAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MALKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-410-1374
Mailing Address - Street 1:100 W KINGSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3961
Mailing Address - Country:US
Mailing Address - Phone:718-410-1374
Mailing Address - Fax:
Practice Address - Street 1:100 W KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3961
Practice Address - Country:US
Practice Address - Phone:718-410-1374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-24
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment