LIBERTY RC INC NPI 1164670113

NPI Information

NPI: 1164670113
Provider Name: LIBERTY RC INC

Doing Business As: YONKERS EAST DIALYSIS CENTER

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
5 ODELL PLZ
STE 131
YONKERS, NY
ZIP 10701
Phone: (914) 376-0296
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LIBERTY RC INC is an end-stage renal disease (esrd) treatment clinic center in Yonkers, NY. LIBERTY RC INC NPI is 1164670113. The provider is registered as an organization entity type.
The provider Is Doing Business As Yonkers East Dialysis Center.

The provider's business location address is:

5 ODELL PLZ
STE 131
YONKERS, NY
ZIP 10701-406
Phone: (914) 376-0296
Fax: (914) 376-3510

The provider's authorized official is Samuel Wey .
The authorized official title is Sr Dir, Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 33D1091783 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/3/2008 and was last updated on 8/10/2023.

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	03180283	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: 4/28/2024

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