Provider Demographics
NPI:1699936195
Name:KIDNEY DOCTORS, PLLC
Entity type:Organization
Organization Name:KIDNEY DOCTORS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINCIC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-594-2724
Mailing Address - Street 1:184 W MONTAUK HWY
Mailing Address - Street 2:BLDG C
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2304
Mailing Address - Country:US
Mailing Address - Phone:631-594-2724
Mailing Address - Fax:631-685-1453
Practice Address - Street 1:184 W MONTAUK HWY
Practice Address - Street 2:BLDG C
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2304
Practice Address - Country:US
Practice Address - Phone:631-594-2724
Practice Address - Fax:631-685-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202633207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000198Medicare PIN