Provider Demographics
NPI:1023178514
Name:LIFE CARE NEPHROLOGY GROUP L.L.P
Entity Type:Organization
Organization Name:LIFE CARE NEPHROLOGY GROUP L.L.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:WASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-977-3100
Mailing Address - Street 1:211 W 61ST ST
Mailing Address - Street 2:LEVEL 'B'
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7832
Mailing Address - Country:US
Mailing Address - Phone:212-977-3100
Mailing Address - Fax:212-977-3475
Practice Address - Street 1:211 W 61ST ST
Practice Address - Street 2:LEVEL 'B'
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7832
Practice Address - Country:US
Practice Address - Phone:212-977-3100
Practice Address - Fax:212-977-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW9L271Medicare PIN