LIBERTY RC INC NPI 1043377922

NPI Information

NPI: 1043377922
Provider Name: LIBERTY RC INC

Doing Business As: EASTCHESTER ROAD DIALYSIS CENTER

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
1515 JARRETT PL
BRONX, NY
ZIP 10461
Phone: (718) 822-4940
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LIBERTY RC INC is an end-stage renal disease (esrd) treatment clinic center in Bronx, NY. LIBERTY RC INC NPI is 1043377922. The provider is registered as an organization entity type.
The provider Is Doing Business As Eastchester Road Dialysis Center.

The provider's business location address is:

1515 JARRETT PL
BRONX, NY
ZIP 10461-606
Phone: (718) 822-4940
Fax: (718) 822-3083

The provider's authorized official is John D Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 33D1072409 - end stage renal disease dialysis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/2/2007 and was last updated on 7/9/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	02950190	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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