Legacy Dialysis of Reston LLC

Primary specialty

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

Legal business name

LEGACY DIALYSIS OF RESTON LLC

Practice address

1897 Preston White Dr Ste 105
Reston, VA 20191-5475

Phone

(954) 781-7741

Fax

(888) 349-8679

NPI assigned

Sep 28, 2021

Reactivated

May 26, 2023

Organization subpart

No

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

Authorized official

Name

Nicole Joyner

Title

Admin

Phone

(954) 729-5434

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685059200000",
    "number": "1720759814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E SAMPLE RD STE 220",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330643554",
            "telephone_number": "954-781-7741",
            "fax_number": "888-349-8679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1897 PRESTON WHITE DR STE 105",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201915475",
            "telephone_number": "954-781-7741",
            "fax_number": "888-349-8679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DIALYSIS OF RESTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-28",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "deactivation_date": "2023-03-04",
        "reactivation_date": "2023-05-26",
        "status": "A",
        "authorized_official_last_name": "JOYNER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "954-729-5434"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paula Renee Lee, L.AC.
• Seon H Lee, MD
• Seungjae Lee
• Siew Mei Lee, M.D.
• Legacy Dialysis of Reston Clinic
• Daniel Lehnert, PT, DPT
• Karen A Lensing, ATC
• Gemma Leonard, DPT
• Kyler Leonard, FNP-C
• Martin Stewart Lerman, MD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Reston, VA
• Providers in Reston, VA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; 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.