Provider Demographics
NPI:1063452563
Name:BRONX RIVER NEPHRO-CARE INC.
Entity Type:Organization
Organization Name:BRONX RIVER NEPHRO-CARE INC.
Other - Org Name:BRONX RIVER NEPHRO-CARE AT THE PLAZA REHAB & NURSING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-644-9276
Mailing Address - Street 1:1616 BRONXDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3302
Mailing Address - Country:US
Mailing Address - Phone:718-430-9800
Mailing Address - Fax:718-430-6854
Practice Address - Street 1:100 W KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3903
Practice Address - Country:US
Practice Address - Phone:718-579-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRONX RIVER NEPHRO-CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000249R261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01812064Medicaid
332640Medicare PIN