Provider Demographics
NPI:1558532242
Name:MEDICAL DIAGNOSTIC NEPHROLOGY, PC
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC NEPHROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:AFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-231-7800
Mailing Address - Street 1:2409 BARKER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7601
Mailing Address - Country:US
Mailing Address - Phone:718-231-7800
Mailing Address - Fax:718-231-7850
Practice Address - Street 1:2409 BARKER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7601
Practice Address - Country:US
Practice Address - Phone:718-231-7800
Practice Address - Fax:718-231-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206326207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty