Organization
MAIN STREET DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IHEANYICHUKWU AJA-ONU M.D. (MEMBER)
(516) 771-7112
Entity
Organization
Contact information
Practice address
3 N MAIN ST, FREEPORT, NY 11520-2218
(516) 825-2076
Mailing address
PO BOX 037216, ELMONT, NY 11003-7216
(516) 771-7112
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
052083-B
NY
Other
Enumeration date
01/19/2016
Last updated
05/04/2023
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