Organization
WEST NASSAU DIALYSIS CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J. GANESH BHAT MD (PRESIDENT)
(718) 366-1111
Entity
Organization
Contact information
Practice address
75 ROCKAWAY AVE, VALLEY STREAM, NY 11580-5808
(516) 823-4444
(516) 823-4445
Mailing address
2314 COLLEGE POINT BLVD, COLLEGE POINT, NY 11356-2526
(516) 823-4444
(516) 823-4445
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
2910200R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02103166
—
NY
01
—
022223
EMPIRE BCBS
NY
Enumeration date
07/14/2005
Last updated
03/04/2015
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