Provider Demographics
NPI:1710914056
Name:SOUTH BROOKLYN NEPHROLOGY CENTER INC
Entity Type:Organization
Organization Name:SOUTH BROOKLYN NEPHROLOGY CENTER INC
Other - Org Name:SOUTH BROOKLYN NEPHROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DR
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-256-5800
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:STE 400 L&C
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-320-4521
Mailing Address - Fax:866-594-2894
Practice Address - Street 1:3915 AVENUE V
Practice Address - Street 2:STE 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:2006-06-26
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00698095Medicaid
332516Medicare Oscar/Certification