ISLAND REHABILITATIVE SERVICES CORP (NPI# 1669453502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669453502 |
| Entity Type | Organization |
| Organization Name | ISLAND REHABILITATIVE SERVICES CORP |
| Practice Address |
25 Fanning St Staten Island NY 10314-5307 |
| Mailing Address |
97 New Dorp Ln Staten Island NY 10306-2364 |
| Practice Telephone | 3476718399 |
| Practice Fax Number | 3476718398 |
| Mailing Telephone | 7184485641 |
| Mailing Fax Number | 7188765969 |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2011-09-28 |
| Authorized Official Name | MR. DOMINIC LICCIARDI (ADMINISTRATOR) |
| Authorized Official Telephone | 7189875942 |
| Is Organization Subpart | Y |
| Parent Organization Name | ISLAND REHABILITATIVE SERVICES CORP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
7004204R | NY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00519755 | 05 | |
| NY | 03004235 | 05 |
| Street Address |
25 FANNING ST |
| City | STATEN ISLAND |
| State | NY |
| Zip Code | 10314-5307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417952417 | Clove Lakes Health Care and Rehabilitation Center, Inc. | Skilled Nursing Facility | 25 Fanning St, Staten Island, NY 10314-5307 | 2005-06-16 |
| 1134676588 | N/a | Clinic/Center | 25 Fanning St, Staten Island, NY 10314-5307 | 2016-09-01 |
| 1285038141 | Wuraola Ismaila | Registered Nurse | 25 Fanning St, Staten Island, NY 10314-5307 | 2014-10-21 |
| 1306086707 | Suma Mariam Kuriakose | Physical Therapist | 25 Fanning St, Staten Island, NY 10314-5307 | 2009-02-24 |
| 1750506853 | John Thomas | Physical Therapy Assistant | 25 Fanning St, Staten Island, NY 10314-5307 | 2007-04-16 |
| 1659314193 | Clove Lakes Rehabilitation and Outpatient Services | Speech-Language Pathologist | 25 Fanning St, Staten Island, NY 10314-5307 | 2006-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076255 | Edward Leccese | Massage Therapist | 77 Renee Place, Staten Island, NY 10314 | 2020-09-01 |
| 1871154633 | Matthew Richard Puliatti | Counselor | 1688 Victory Boulevard, Staten Island, NY 10314 | 2019-06-24 |
| 1750845137 | Miriam Gordon Pediatric Np PC | Nurse Practitioner | 7 Ismay Street, Staten Island, NY 10314 | 2019-01-30 |
| 1003391186 | 2791 Richmond LLC | Dentist | 2791 Richmond Avenue, Suite 2, Staten Island, NY 10314 | 2018-09-25 |
| 1477046522 | Miriam A Madry | Optometrist | 569 Woolley Ave, Staten Island, NY 10314 | 2018-06-13 |
| 1174025894 | Staten Island Dentistry P.C. | Clinic/Center | 979 Willowbrook Rd., Staten Island, NY 10314 | 2018-03-08 |
| 1205335023 | Ashley Larsen | Early Intervention Provider Agency | 229 Wellington Ct, Staten Island, NY 10314 | 2018-02-07 |
| 1306369699 | Victoria Ali | Behavior Technician | 228 Melvin Avenue, Staten Island, NY 10314 | 2017-07-19 |
| 1700307360 | Lydia Mora | Specialist | 2025 Richmond Avenue Suite 200, Staten Island, NY 10314 | 2017-07-03 |
| 1366971707 | Lisa Pietracatella | Massage Therapist | 92 Margaretta Court, Staten Island, NY 10314 | 2017-06-08 |
| Find all providers in zip 10314 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245731876 | Knickerbocker Dialysis Inc | Clinic/Center | 30 Sneden Ave, Staten Island, NY 10312-3637 | 2018-02-28 |
| 1366876948 | Knickerbocker Dialysis Inc | Clinic/Center | 1139 Hylan Blvd, Staten Island, NY 10305-2061 | 2013-08-30 |
| 1235130840 | Island Rehabilitative Services Corp. | Clinic/Center | 470 Seaview Ave, Staten Island, NY 10305-3401 | 2005-08-04 |
| 1760905459 | Dialysis Clinic Inc | Clinic/Center | 135 Vanderbilt Ave, Staten Island, NY 10304-2604 | 2017-07-25 |
| 1033131529 | Dialysis Clinic Inc. | Clinic/Center | 800 Castleton Ave, Staten Island, NY 10310-1819 | 2006-07-24 |
| 1518990993 | Dialysis Clinic Inc. | Clinic/Center | 1550 Richmond Ave, Staten Island, NY 10314-1578 | 2006-07-08 |
| 1679517270 | Knickerbocker Dialysis Inc | Clinic/Center | 1366 Victory Blvd, Staten Island, NY 10301-3907 | 2006-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194323071 | True North Dialysis Center LLC | Clinic/Center | 668 Middle Country Rd, Selden, NY 11784-2521 | 2020-10-13 |
| 1952908386 | Ulster Dialysis, LLC | Clinic/Center | 900 Miron Ln, Kingston, NY 12401-1567 | 2020-10-08 |
| 1376152868 | True North Dialysis Center LLC | Clinic/Center | 3005 Long Beach Rd, Oceanside, NY 11572 | 2020-07-30 |
| 1043839269 | Knickerbocker Dialysis Inc | Clinic/Center | 5518 Avenue N, Brooklyn, NY 11234-4006 | 2020-04-09 |
| 1942839378 | Knickerbocker Dialysis Inc | Clinic/Center | 479 E Main St, Patchogue, NY 11772-3147 | 2020-04-07 |
| 1225667819 | New York Dialysis Services, Inc | Clinic/Center | 1 East Jericho Turnpike, Mineola, NY 11501 | 2020-04-06 |
| 1205461639 | Knickerbocker Dialysis Inc | Clinic/Center | 1277 Middle Country Rd, Middle Island, NY 11953 | 2020-03-05 |
| 1326678111 | New York Dialysis Services, Inc | Clinic/Center | 794 St Anns Ave, Bronx, NY 10456 | 2020-01-21 |
| 1629617576 | Knickerbocker Dialysis Inc | Clinic/Center | 1633 Route 202 Ste 120, Pomona, NY 10970-2926 | 2019-12-24 |
| 1740824184 | Knickerbocker Dialysis Inc | Clinic/Center | 11 Romaine Ave, Yonkers, NY 10705 | 2019-10-29 |
| Find all providers with the same taxonomy | ||||
| City | STATEN ISLAND |
| Zip Code | 10314 |
Please comment or provide details below to improve the information on ISLAND REHABILITATIVE SERVICES CORP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.