Active NPI
Huntington Artificial Kidney Center LTD
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Medford, NY
National Provider Identifier
1487682134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- 5153202R
- Legal business name
- HUNTINGTON ARTIFICIAL KIDNEY CENTER LTD
- Practice address
- 1725 N Ocean Ave
Medford, NY 11763-2649 - Phone
- (631) 289-8000
- Fax
- (631) 289-8079
- NPI assigned
- Jun 30, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Samuel Wey
- Title
- Assistant Secretary
- Phone
- (615) 341-6641
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 5153202R | NY | Primary |
Addresses
Primary practice location
1725 N Ocean Ave
Medford, NY 11763-2649
Mailing address
5200 Virginia Way
L & C Dept
Brentwood, TN 37027-7569
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03069707 | Medicaid | NY |
Other names 1
- Medford Kidney Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110629000427 | NY | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 1759292774 | Practice locations: Medford, NY |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Freeport, NY
- NPI 1740216159
1759292774
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1733270400000",
"number": "1487682134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5200 VIRGINIA WAY",
"address_2": "L & C DEPT",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370277569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 N OCEAN AVE",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117632649",
"telephone_number": "631-289-8000",
"fax_number": "631-289-8079"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HUNTINGTON ARTIFICIAL KIDNEY CENTER LTD",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-30",
"last_updated": "2024-12-04",
"certification_date": "2024-12-04",
"status": "A",
"authorized_official_last_name": "WEY",
"authorized_official_first_name": "SAMUEL",
"authorized_official_title_or_position": "ASSISTANT SECRETARY",
"authorized_official_telephone_number": "615-341-6641"
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "NY",
"license": "5153202R",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03069707",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Medford Kidney Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Medford Kidney Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.