Organization
TIDAL DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PREMILA BHAT MD (MANAGING MEMBER)
(718) 899-0060
Entity
Organization
Contact information
Practice address
336 HIMROD ST, BROOKLYN, NY 11237-4871
(718) 899-0060
(718) 559-6758
Mailing address
385 SENECA AVE, RIDGEWOOD, NY 11385-1340
(718) 899-0060
(718) 559-6758
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
07/31/2025
Last updated
07/31/2025
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