Organization
ISLAND REHABILITATIVE SERVICES/B'KLYN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIC LICCIARDI (ADMINISTRATOR)
(718) 437-1594
Entity
Organization
Contact information
Practice address
5918-5924 13TH AVE, ISLAND REHABILITATIVE SERVICES/B'KLYN, BROOKLYN, NY 11219
(718) 437-1594
(718) 437-5092
Mailing address
2031-10 FOREST AVE, ISLAND REHABILITATIVE SERVICES, STATEN ISLAND, NY 10303-1796
(718) 448-5641
(718) 448-6117
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
08/31/2005
Last updated
07/21/2022
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