Provider Demographics
NPI:1982887675
Name:CENTRAL NEW HAMPSHIRE NEPHROLOGY CLINIC, PLLC
Entity Type:Organization
Organization Name:CENTRAL NEW HAMPSHIRE NEPHROLOGY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NOSHI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-524-8896
Mailing Address - Street 1:87 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3156
Mailing Address - Country:US
Mailing Address - Phone:603-524-8896
Mailing Address - Fax:603-524-8796
Practice Address - Street 1:87 SPRING ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3156
Practice Address - Country:US
Practice Address - Phone:603-524-8896
Practice Address - Fax:603-524-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE4253OtherMEDICARE OLD PIN
NHRE4253OtherMEDICARE OLD PIN