Organization
SOUTH SHORE DIALYSIS INC. - BELLMORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CORENE KORBA (BILLING MANAGER)
(914) 644-9276
Entity
Organization
Contact information
Practice address
250 PETTIT AVE, BELLMORE, NY 11710-3657
(516) 679-3090
Mailing address
250 PETTIT AVE, BELLMORE, NY 11710-3657
(516) 679-3090
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
2906202R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00803892
—
NY
01
—
009261
EMPIRE BLUE CROISS
NY
Enumeration date
06/14/2006
Last updated
07/21/2022
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