Provider Demographics
NPI:1083206833
Name:NOVO DIALYSIS FLATLANDS LLC
Entity Type:Organization
Organization Name:NOVO DIALYSIS FLATLANDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ADITYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-284-1122
Mailing Address - Street 1:780 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2238
Mailing Address - Country:US
Mailing Address - Phone:540-254-7750
Mailing Address - Fax:
Practice Address - Street 1:2306 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3840
Practice Address - Country:US
Practice Address - Phone:540-254-7791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment