Provider Demographics
NPI:1548346604
Name:NEW YORK ARTIFICIAL KIDNEY CENTER INC
Entity type:Organization
Organization Name:NEW YORK ARTIFICIAL KIDNEY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANTUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-769-4100
Mailing Address - Street 1:2651 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3915
Mailing Address - Country:US
Mailing Address - Phone:718-769-4100
Mailing Address - Fax:718-769-4105
Practice Address - Street 1:2701 EMMONS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2209
Practice Address - Country:US
Practice Address - Phone:718-769-4100
Practice Address - Fax:718-769-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001102R261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02259218Medicaid
NY33-2622Medicare ID - Type Unspecified