Main Street Kidney Group

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

MAIN STREET KIDNEY GROUP

Practice address

3 N Main St
Freeport, NY 11520-2218

Phone

(516) 623-5076

NPI assigned

Mar 29, 2021

Last updated

Mar 29, 2021By 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

Dr. Iheanyichukwu Aja-Onu, MDNPI 1720077944

Title

Ceo

Phone

(516) 623-5076

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Iheanyichukwu Aja-Onu, M.D.

  • Gastroenterology Physician
  • Freeport, NY
  • NPI 1720077944
  NPD Authorized official

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1992383319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37216",
            "city": "ELMONT",
            "state": "NY",
            "postal_code": "110037216",
            "telephone_number": "516-623-5076",
            "fax_number": "516-623-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 N MAIN ST",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115202218",
            "telephone_number": "516-623-5076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET KIDNEY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-29",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "AJA-ONU",
        "authorized_official_first_name": "IHEANYICHUKWU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "516-623-5076",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Akiya Shant'E Mack, LPN
• Chukwuma Madu, PHARM.D.
• Michelle Anne Magalios, MSW
• Miguelina Magarin, LPN
• Main Street Dialysis Center LLC
• Hyitreal Maitre
• Maxo Junior Maitre
• Kathleen Marie Malizia
• Sylvia Mamani, D.O.
• Manifesting Dreams Inc

• Nephrology Physician in Freeport, NY
• Providers in Freeport, NY by specialty
• Nephrology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.