Organization
ISLAND REHABILITATIVE SERVICES CORP.
Active
Parent organization
ISLAND REHABILITATIVE SERVICES CORP.
Organization subpart
Yes
Provider details
NPI number
Legal business name
ISLAND REHABILITATIVE SERVICES CORP.
Authorized official
MR. DOMINIC LICCIARDI (ADMINISTRATOR)
(718) 987-5942
Entity
Organization
Contact information
Practice address
470 SEAVIEW AVE, STATEN ISLAND, NY 10305-3401
(718) 987-5942
(718) 667-9708
Mailing address
97 NEW DORP LN, STATEN ISLAND, NY 10306-2364
(718) 448-5641
(718) 876-5969
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00519755
—
NY
Enumeration date
08/04/2005
Last updated
07/21/2022
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