Organization · Type 2 NPI

Concourse Replacement LLC

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Bronx, NY

NPI number 1740400431 Active

Practice location

1490 Macombs Rd
Bronx, NY 10452-2101

Call (718) 583-1800 Map

Fax (718) 583-4160

Mailing address

97 New Dorp Ln
Staten Island, NY 10306-1796

Other practice locations

1780 Grand Concourse, Bronx, NY 10457-5500 · (718) 583-1800

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	None listed

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

Another provider at this address

Knickerbocker Dialysis IncEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center Bronx, NY NPI 1063911659

Other end-stage renal disease (esrd) treatment clinic/center providers in Bronx

See all in Bronx →

NPI record

NPI: 1740400431
Entity type: Organization (Type 2)
Issued: Apr 26, 2007
Last updated: Mar 1, 2026
Status: Active

Other names

<unavail>
Grand Concourse Dialysis Facility · doing business as
Grand Concourse Dialysis Facility · doing business as

Authorized official

Mr. Dominic Licciardi
Administrator
(718) 987-5942

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About NPI 1740400431

Concourse Replacement LLC's National Provider Identifier is 1740400431, issued on Apr 26, 2007. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Bronx, NY. The record was last updated on Mar 1, 2026.