Provider Demographics
NPI:1457373359
Name:BROOKLYN HOME DIALYSIS TRAINING CENTER, INC.
Entity type:Organization
Organization Name:BROOKLYN HOME DIALYSIS TRAINING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UNIT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINDOS-CARBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:917-576-0013
Mailing Address - Street 1:PO BOX 40731
Mailing Address - Street 2:STAPLETON STATION
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-0731
Mailing Address - Country:US
Mailing Address - Phone:917-576-0013
Mailing Address - Fax:
Practice Address - Street 1:3131 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:917-576-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332322261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY332333Medicare ID - Type Unspecified