Provider Demographics
NPI:1679698765
Name:CENTRAL NEW HAMPSHIRE KIDNEY CENTER,LLC
Entity type:Organization
Organization Name:CENTRAL NEW HAMPSHIRE KIDNEY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NOSHI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-528-3738
Mailing Address - Street 1:87 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246
Mailing Address - Country:US
Mailing Address - Phone:603-528-3738
Mailing Address - Fax:603-524-8796
Practice Address - Street 1:87 SPRING STREET
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246
Practice Address - Country:US
Practice Address - Phone:603-528-3738
Practice Address - Fax:603-524-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1641261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007939Medicaid
NH30007939Medicaid