Rockaway Kidney Center LLC
Clinic/Center, Medical Specialty in Far Rockaway, NY. Organization (NPI-2).
NPI number1669925533
StatusActive
Last updated in NPPESJul 27, 2016
Details
- NPI
- 1669925533
- Entity type
- Organization (NPI-2)
- Legal business name
- Rockaway Kidney Center LLC
- Organization subpart
- No
- Enumeration date
- Jul 27, 2016
- Last updated
- Jul 27, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM2500X | Clinic/Center, Medical Specialty | – | – | Yes |
Practice location
529 Beach 20th StFar Rockaway, NY 11691-3645
Phone 516-770-5712 · Fax 718-228-8036
Mailing address
529 Beach 20th StFar Rockaway, NY 11691-3645
Phone 516-770-5712 · Fax 718-228-8036
Authorized official
Olusegun Ogunfowora
MD
5167705712
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