Provider Demographics
NPI:1801065388
Name:BROOKLYN DIALYSIS CENTER, LLC
Entity type:Organization
Organization Name:BROOKLYN DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-698-1260
Mailing Address - Street 1:915 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3203
Mailing Address - Country:US
Mailing Address - Phone:347-915-2140
Mailing Address - Fax:347-915-2152
Practice Address - Street 1:915 DEAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3203
Practice Address - Country:US
Practice Address - Phone:347-915-2140
Practice Address - Fax:347-915-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment