Organization
CONCOURSE REPLACEMENT LLC
Active
Other names
Grand Concourse Dialysis Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOMINIC LICCIARDI (ADMINISTRATOR)
(718) 987-5942
Entity
Organization
Contact information
Practice address
1490 MACOMBS RD, BRONX, NY 10452-2101
(718) 583-1800
(718) 583-4160
Mailing address
97 NEW DORP LN, STATEN ISLAND, NY 10306-1796
(718) 448-5641
(718) 876-5969
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02986203
—
NY
Enumeration date
04/26/2007
Last updated
03/01/2026
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