Kew Gardens Dialysis Center

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

KEW GARDENS DIALYSIS CENTER

Practice address

12046 Queens Blvd
Kew Gardens, NY 11415-1204

Phone

(718) 793-3341

Fax

(718) 268-1666

NPI assigned

Jun 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dominic Licciardi

Title

Coo

Phone

(718) 987-5942

Specialties & licenses 1

Addresses

Tax ID family

Kew Gardens Dialysis Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Queens Replacement LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Kew Gardens, NY
  • NPI 1548251218
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364947200000",
    "number": "1295931624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 NEW DORP LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103062364",
            "telephone_number": "718-448-5641",
            "fax_number": "718-876-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12046 QUEENS BLVD",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114151204",
            "telephone_number": "718-793-3341",
            "fax_number": "718-268-1666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEW GARDENS DIALYSIS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-22",
        "last_updated": "2013-04-03",
        "status": "A",
        "authorized_official_last_name": "LICCIARDI",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "718-987-5942",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tahsin Kazi-Islam
• Marie Keogh, MPH, RD, CDN, IBCLC
• Maxwell Ketschke
• Kew Gardens Center for Wellness
• Kew Gardens Dental P.C
• Kew Gardens Drug Corp
• Kew Gardens Family Dental,PLLC
• Kew Gardens Family Physicians, LLP
• Kew Gardens Pharmacy Inc
• Fatema Khandaker

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Kew Gardens, NY
• Providers in Kew Gardens, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.