Provider Demographics
NPI:1669681318
Name:KINGS RENAL SERVICES, PC
Entity Type:Organization
Organization Name:KINGS RENAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-648-0101
Mailing Address - Street 1:3915 AVENUE V
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5156
Mailing Address - Country:US
Mailing Address - Phone:718-252-8440
Mailing Address - Fax:718-252-6490
Practice Address - Street 1:3915 AVENUE V
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5156
Practice Address - Country:US
Practice Address - Phone:718-252-8440
Practice Address - Fax:718-252-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW9L761Medicare PIN