Provider Demographics
NPI:1063685436
Name:NY KIDNEY HYPERTENSION, PLLC
Entity Type:Organization
Organization Name:NY KIDNEY HYPERTENSION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUCCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-881-2100
Mailing Address - Street 1:PO BOX 1042
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-9042
Mailing Address - Country:US
Mailing Address - Phone:718-881-2100
Mailing Address - Fax:718-881-5164
Practice Address - Street 1:3322 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2849
Practice Address - Country:US
Practice Address - Phone:718-881-2100
Practice Address - Fax:718-881-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211368207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02560850Medicaid
NY02560850Medicaid