Island Rehabilitative Services/Bronx

Primary specialty

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

Legal business name

ISLAND REHABILITATIVE SERVICES/BRONX

Practice address

1780 Grand Concourse
Bronx, NY 10457-5500

Phone

(718) 583-1800

Fax

(718) 583-4160

NPI assigned

Sep 2, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dominic Licciardi

Title

Administrator

Phone

(718) 987-5942

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Concourse Replacement LLC2 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.

• Concourse Replacement LLC

  dba Grand Concourse Dialysis Facility

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bronx, NY
  • NPI 1740400431
  NPD tax ID

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1649264839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103031796",
            "telephone_number": "718-448-5641",
            "fax_number": "718-448-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104575500",
            "telephone_number": "718-583-1800",
            "fax_number": "718-583-4160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND REHABILITATIVE SERVICES/BRONX",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-02",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LICCIARDI",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "718-987-5942"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00519755",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florinda Islamovic-Jacob
• Nermina Islamovic, PA-C
• Island Medical and Psychiatric PC
• Island Musculoskeletal Care, M.D., P.C.
• Island Pharmacy & Discount Corp (Island Pharmacy & Discount)
• Alison Ismael, PA
• Amira Ismail
• Dina Ismail, M.D.
• Nile Ismail, DDS
• Sarah Ismail, MS, CCC-SLP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Bronx, NY
• Providers in Bronx, 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 Jul 21, 2022; 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.