Provider Demographics
NPI:1073549192
Name:IHS OF NEW YORK INC
Entity Type:Organization
Organization Name:IHS OF NEW YORK INC
Other - Org Name:PELHAM PARKWAY DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-361-1113
Mailing Address - Street 1:6001 BROKEN SOUND PKWY
Mailing Address - Street 2:SUITE 508
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2765
Mailing Address - Country:US
Mailing Address - Phone:561-443-0743
Mailing Address - Fax:561-443-7296
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:JACOBI MEDICAL CENTER BLDG 5 A1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-409-1909
Practice Address - Fax:718-409-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03009161Medicaid
NY03009161Medicaid