Provider Demographics
NPI:1750308748
Name:WOODMERE DIALYSIS,LLC
Entity Type:Organization
Organization Name:WOODMERE DIALYSIS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-374-9300
Mailing Address - Street 1:121 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1218
Mailing Address - Country:US
Mailing Address - Phone:516-374-9300
Mailing Address - Fax:516-374-1786
Practice Address - Street 1:121 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1218
Practice Address - Country:US
Practice Address - Phone:516-374-9300
Practice Address - Fax:516-374-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2007-10-12
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
NY02860979Medicaid
NY02860979Medicaid