Provider Demographics
NPI:1639159775
Name:NASSAU NEPHROLOGY LLP
Entity Type:Organization
Organization Name:NASSAU NEPHROLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:CASELNEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-409-0106
Mailing Address - Street 1:250 PETTIT AVENUE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:516-409-0106
Mailing Address - Fax:516-409-0108
Practice Address - Street 1:250 PETTIT AVENUE
Practice Address - Street 2:SUITE 4
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710
Practice Address - Country:US
Practice Address - Phone:516-409-0106
Practice Address - Fax:516-409-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02044677Medicaid
NY=========OtherTIN