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
25 FANNING ST, STATEN ISLAND, NY 10314-5307
(347) 671-8399
(347) 671-8398
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
7004204R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00519755
—
NY
05
—
03004235
—
NY
Enumeration date
11/08/2005
Last updated
09/28/2011
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