Provider Demographics
NPI:1972630283
Name:PREMIER HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PREMIER HEALTH SERVICES, INC.
Other - Org Name:POLA TENENBAUM CENTER FOR RENAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:TENENBAUM
Authorized Official - Last Name:SIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-796-8100
Mailing Address - Street 1:430 BEACH 68TH ST
Mailing Address - Street 2:DIALYSIS UNIT
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1407
Mailing Address - Country:US
Mailing Address - Phone:718-474-0357
Mailing Address - Fax:718-474-1948
Practice Address - Street 1:430 BEACH 68TH ST
Practice Address - Street 2:DIALYSIS UNIT
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1407
Practice Address - Country:US
Practice Address - Phone:718-474-0357
Practice Address - Fax:718-474-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001287R261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY332594Medicare ID - Type Unspecified