Provider Demographics
NPI:1588002315
Name:KIDNEY CARE OF BROOKLYN AND QUEENS, PLLC
Entity type:Organization
Organization Name:KIDNEY CARE OF BROOKLYN AND QUEENS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-369-0318
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10116-0450
Mailing Address - Country:US
Mailing Address - Phone:718-369-0318
Mailing Address - Fax:718-369-0290
Practice Address - Street 1:577 PROSPECT AVENUE
Practice Address - Street 2:#1-B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6065
Practice Address - Country:US
Practice Address - Phone:718-369-0318
Practice Address - Fax:718-369-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136867207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty