Concourse Replacement LLC

Primary specialty

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

Legal business name

CONCOURSE REPLACEMENT LLC

Doing business as

Grand Concourse Dialysis Facility

Practice address

1490 Macombs Rd
Bronx, NY 10452-2101

Phone

(718) 583-1800

Fax

(718) 583-4160

NPI assigned

Apr 26, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Dominic Licciardi

Title

Administrator

Phone

(718) 987-5942

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Grand Concourse Dialysis Facility Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Listed as

Grand Concourse Dialysis FacilityCCN 332642

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jun 28, 2004

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

27

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

CLIA laboratory certificates

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.

• Island Rehabilitative Services/Bronx

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bronx, NY
  • NPI 1649264839
  NPD tax ID

Member of 2

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

• Bronxcare Special Care Center

  • Skilled Nursing Facility
  • Bronx, NY
  • NPI 1639255797

  Member Of

  NPD member
• Island Rehabilitative Services Corp.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Staten Island, NY
  • NPI 1235130840

  Member Of

  NPD member

Locations

Practitioners 1

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

• Mahendraray B Dave

  • Specialist
  • Bronx, NY
  • NPI 1144391251
  NPD (past)

Affiliated clinicians 2

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

• Rabih Nasr, M.D.

  • Nephrology Physician
  • Bronx, NY
  • NPI 1831334754

  Dialysis facility

  Care Compare affiliation Name & address match
• Kalpana A Uday, M.D.

  • Nephrology Physician
  • Bronx, NY
  • NPI 1043263882

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772323200000",
    "number": "1740400431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 NEW DORP LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103061796",
            "telephone_number": "718-448-5641",
            "fax_number": "718-876-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 MACOMBS RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104522101",
            "telephone_number": "718-583-1800",
            "fax_number": "718-583-4160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1780 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104575500",
            "country_code": "US",
            "telephone_number": "718-583-1800",
            "fax_number": "718-583-4160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CONCOURSE REPLACEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2026-03-01",
        "certification_date": "2026-03-01",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02986203",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Concourse Dialysis Facility",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Concourse Dialysis Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Concourse Pediatrics
• Concourse Pharmacy Inc.
• Concourse Plaza Dental Associates PC
• Concourse Plaza Family Dental LLC
• Concourse Rehab & Nursing Ctr Inc.
• Concourse Village Primary Care PLLC
• Concourse West Dental PLLC
• Concourse West Management Inc
• Maria Conde-Rojas
• Loismarie Dangazo Condeza

• 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 Mar 1, 2026; 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.