Organization
ATLANTIC DIALYSIS MANAGEMENT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODUMUTT GANESH BHAT MD (PRINCIPAL)
(718) 821-3182
Entity
Organization
Contact information
Practice address
2314 COLLEGE POINT BLVD, COLLEGE POINT, NY 11356-2526
(718) 483-7428
(718) 821-3182
Mailing address
2314 COLLEGE POINT BLVD, COLLEGE POINT, NY 11356-2526
(718) 483-7428
(718) 821-3182
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
7003241R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03352696
NYS DOH SERVICE BUREAU PROVIDER ID
NY
Enumeration date
01/10/2012
Last updated
01/10/2012
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