Main Street Dialysis Center LLC

NPI #1306203609 in Freeport, New York

Provider Information

NPI Number: 1306203609
Entity Type: Organization
Organization Name: Main Street Dialysis Center LLC
Primary Specialty: Clinic/Center - End-Stage Renal Disease (ESRD) Treatment
Enumeration Date: Jan 19, 2016
Last Updated: May 4, 2023

Practice Location

Address: 3 N MAIN ST
City: Freeport
State: New York
ZIP Code: 11520-2218
Phone: (516) 825-2076

Authorized Official

Name: DR. IHEANYICHUKWU AJA-ONU, M.D.
Title: MEMBER
Phone: (516) 771-7112

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment — End-Stage Renal Disease (ESRD) Treatment	261QE0700X	Primary

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