True North III DC LLC

Primary specialty

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

Legal business name

TRUE NORTH III DC LLC

Doing business as

Grand Boulevard Dialysis

Practice address

860 Grand Blvd
Deer Park, NY 11729-5706

Phone

(631) 243-7770

Fax

(631) 243-7775

NPI assigned

Nov 19, 2024

Organization subpart

No

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) 320-4414

Specialties & licenses 1

Addresses

Other names 1

• Grand Boulevard Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Knickerbocker Dialysis Inc

  dba Northtowns Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tonawanda, NY
  • NPI 1902142607

  Member Of

  NPD member
• North Shore Long Island Jewish Healthcare Inc.

  dba Long Island Hyperbaric & Wound Care

  • Surgery Physician
  • Westbury, NY
  • NPI 1427428150

  Member Of

  NPD member
• North Shore University Hospital

  • General Acute Care Hospital
  • Manhasset, NY
  • NPI 1366459570

  Member Of

  NPD member

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

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1740005388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L AND C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 GRAND BLVD",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117295706",
            "telephone_number": "631-243-7770",
            "fax_number": "631-243-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUE NORTH III DC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-19",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "615-320-4414"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Boulevard Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Annelise R Thompson, OTR/L
• Thomas P Tini, DC
• Gerard Toughey, PT
• Donato Tramontozzi
• True Blessings Companion Aides & Staffing Agency
• True Support Services Inc
• Michael Turner, CRPA
• Zeynep Ulku, DDS, DMSC
• Up and on Physicalwellness of Long Island LLC
• Usha Pharmacy Inc (Wil Mark Pharmacy)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Deer Park, NY
• Providers in Deer Park, 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 Nov 19, 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.

Verify at the official NPI Registry.