Provider Demographics
NPI:1982340303
Name:STAR CARE DIALYSIS
Entity Type:Organization
Organization Name:STAR CARE DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR OF EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DONAGHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA
Authorized Official - Phone:631-803-6008
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-0933
Mailing Address - Country:US
Mailing Address - Phone:631-803-6008
Mailing Address - Fax:
Practice Address - Street 1:55 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2133
Practice Address - Country:US
Practice Address - Phone:631-803-6008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1558621631Medicaid