Provider Demographics
NPI:1629372123
Name:NY RENAL CARE PC.
Entity Type:Organization
Organization Name:NY RENAL CARE PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWARKA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RATHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-643-3879
Mailing Address - Street 1:1561 TRYON RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2940
Mailing Address - Country:US
Mailing Address - Phone:914-643-3879
Mailing Address - Fax:917-525-2655
Practice Address - Street 1:242 BULLSBORO DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1295
Practice Address - Country:US
Practice Address - Phone:914-643-3879
Practice Address - Fax:844-330-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205041207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03316896Medicaid