Provider Demographics
NPI:1780891648
Name:EAST END DIALYSIS MANAGEMENT, LLC
Entity type:Organization
Organization Name:EAST END DIALYSIS MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:GANESH
Authorized Official - Last Name:BHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-366-1111
Mailing Address - Street 1:2314 COLLEGE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:792 HARRISON AVE
Practice Address - Street 2:SOUTH BUILDING
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2744
Practice Address - Country:US
Practice Address - Phone:718-483-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-03-04
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
NY332658Medicare Oscar/Certification