Provider Demographics
NPI:1063190064
Name:LONG ISLAND KIDNEY CARE PC
Entity type:Organization
Organization Name:LONG ISLAND KIDNEY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHLAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-261-9988
Mailing Address - Street 1:3 BEECH TREE LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-3150
Mailing Address - Country:US
Mailing Address - Phone:516-261-9988
Mailing Address - Fax:516-612-0071
Practice Address - Street 1:901 STEWART AVE STE 204
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4883
Practice Address - Country:US
Practice Address - Phone:516-261-9988
Practice Address - Fax:516-612-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty