Provider Demographics
NPI:1851455885
Name:BRONX LEBANON NEPHROLOGY, PLLC
Entity Type:Organization
Organization Name:BRONX LEBANON NEPHROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KALPANA
Authorized Official - Middle Name:
Authorized Official - Last Name:UDAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-518-5232
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-0260
Mailing Address - Country:US
Mailing Address - Phone:718-518-5232
Mailing Address - Fax:718-518-5636
Practice Address - Street 1:1650 SELWYN AVE
Practice Address - Street 2:8-G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7626
Practice Address - Country:US
Practice Address - Phone:718-518-5232
Practice Address - Fax:718-518-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-05-07
Deactivation Date:2012-03-28
Deactivation Code:
Reactivation Date:2012-05-01
Provider Licenses
StateLicense IDTaxonomies
NY255628207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03347266Medicaid
1144391251OtherNPI
NY00436677Medicaid
NY01404737Medicaid
1043263882OtherNPI
NY02738810Medicaid
NY1689833303OtherNPI
NYA400049632Medicare PIN
NY27H281Medicare PIN
NY1689833303OtherNPI
NYF49400Medicare UPIN
NY00436677Medicaid
NYWEZ611Medicare PIN