Provider Demographics
NPI:1396780052
Name:MIDWOOD CHAYIM ARUCHIM DIALYSIS ASSOCIATES INC
Entity type:Organization
Organization Name:MIDWOOD CHAYIM ARUCHIM DIALYSIS ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN CLEAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-879-8800
Mailing Address - Street 1:1408 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3803
Mailing Address - Country:US
Mailing Address - Phone:718-677-7600
Mailing Address - Fax:718-677-3265
Practice Address - Street 1:1408 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3803
Practice Address - Country:US
Practice Address - Phone:718-677-7600
Practice Address - Fax:718-677-3265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWOOD CHAYIM ARUCHIM DIALYSIS ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2013-08-23
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
NM02002642Medicaid
NM02002642Medicaid