Main Street Dialysis Center LLC

Primary specialty

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

License

052083-B Issued in NY

Legal business name

MAIN STREET DIALYSIS CENTER LLC

Practice address

3 N Main St
Freeport, NY 11520-2218

Phone

(516) 825-2076

NPI assigned

Jan 19, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Iheanyichukwu Aja-Onu, M.D.NPI 1720077944

Title

Member

Phone

(516) 771-7112

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Listed as

Main Street Dialysis Center, LLCCCN 332753

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Apr 28, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

24

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Iheanyichukwu Aja-Onu, M.D.

  • Gastroenterology Physician
  • Freeport, NY
  • NPI 1720077944
  NPD Authorized official

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Nimesh Kesharichard Shah, MD

  • Nephrology Physician
  • Hollis, NY
  • NPI 1871674051

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1453161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1306203609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 037216",
            "city": "ELMONT",
            "state": "NY",
            "postal_code": "110037216",
            "telephone_number": "516-771-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 N MAIN ST",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115202218",
            "telephone_number": "516-825-2076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-19",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "AJA-ONU",
        "authorized_official_first_name": "IHEANYICHUKWU",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "516-771-7112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "052083-B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaden Anthony Lyons
• Akiya Shant'E Mack, LPN
• Chukwuma Madu, PHARM.D.
• Michelle Anne Magalios, MSW
• Miguelina Magarin, LPN
• Main Street Kidney Group
• Hyitreal Maitre
• Maxo Junior Maitre
• Kathleen Marie Malizia
• Sylvia Mamani, D.O.

• All providers in Freeport, NY
• 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 May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.