Provider Demographics
NPI:1538103494
Name:BRONX RIVER NEPHRO-CARE INC.
Entity Type:Organization
Organization Name:BRONX RIVER NEPHRO-CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
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 1:1616 BRONXDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3302
Practice Address - Country:US
Practice Address - Phone:718-430-9800
Practice Address - Fax:718-430-6854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2017-01-24
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
NY01812064Medicaid
NY01812064Medicaid