Provider Demographics
NPI:1629146279
Name:GOODKIDNEYS MEDICAL, P.C.
Entity Type:Organization
Organization Name:GOODKIDNEYS MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:EL-HENNAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-966-4864
Mailing Address - Street 1:1467 ARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5407
Mailing Address - Country:US
Mailing Address - Phone:718-966-4864
Mailing Address - Fax:718-966-4863
Practice Address - Street 1:1467 ARDEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5407
Practice Address - Country:US
Practice Address - Phone:718-966-4864
Practice Address - Fax:718-966-4863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty