Provider Demographics
NPI:1316977689
Name:BRONX RIVER NEPHRO CARE AT WOODMERE
Entity type:Organization
Organization Name:BRONX RIVER NEPHRO CARE AT WOODMERE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CORENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-644-9276
Mailing Address - Street 1:WOODMERE REHABILITIATION AND HEALTH CARE CENTER
Mailing Address - Street 2:121 FRANKLIN PLACE
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598
Mailing Address - Country:US
Mailing Address - Phone:516-791-5277
Mailing Address - Fax:
Practice Address - Street 1:WOODMERE REHABILITIATION AND HEALTH CARE CENTER
Practice Address - Street 2:121 FRANKLIN PLACE
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598
Practice Address - Country:US
Practice Address - Phone:516-791-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
027391OtherEMPIRE BCBS
NY01812064Medicaid
332634Medicare ID - Type UnspecifiedPROVIDER NUMBER