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ISLAND REHABILITATIVE SERVICES CORP
NPI 1669453502
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Staten Island, NY

Active since November 08, 2005
2/5
Overall Rating
25 FANNING ST, STATEN ISLAND, NY 10314(347) 671-8399(347) 671-8398 Get Directions Write a Review

NPPES record last updated: September 28, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Island Rehabilitative Services Corp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ISLAND REHABILITATIVE SERVICES CORP (NPI 1669453502) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Staten Island, New York and active in the NPI registry since November 2005. The organization lists Dominic Licciardi, Administrator, as its authorized official.

NPPES Registry Identity

NPI1669453502
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameISLAND REHABILITATIVE SERVICES CORP
Location Address25 FANNING STStaten Island, NY 10314-5307
Mailing Address97 New Dorp LnStaten Island, NY 10306-2364 · (718) 448-5641 · Fax (718) 876-5969
Phone(347) 671-8399
Fax(347) 671-8398
Organization SubpartYes
Authorized OfficialDominic LicciardiAdministrator · (718) 987-5942
Enumeration DateNovember 8, 2005
Last NPPES UpdateSeptember 28, 2011
✔ NPI 1669453502 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
License✔ Licensed in NY · 7004204R
25 FANNING ST, Staten Island, NY 10314
Open in Google Maps ↗

Other Identifiers 3

Medicare ID-Type Unspecified332638NY · Medicare Provider Number
Medicaid03004235NY
Medicaid00519755NY

Dialysis Facility Quality Ratings CMS Care Compare

Quality ratings, services and patient survey results for FMC - Island Rehabilitative Services-Clove Lakes Extension (CMS certification number 332638), from CMS Care Compare.

FMC - Island Rehabilitative Services-Clove Lakes Extension

Dialysis facility · Staten Island, NY
2/5 CMS RatingRating period January 2020 to December 2023
OwnershipProfit
CMS Certification Number332638
ESRD NetworkNetwork 2
Hemodialysis Stations8
Medicare-Certified SinceNovember 7, 2003
Location25 FANNING STREETStaten Island, NY 10314 · Richmond County
Phone(347) 671-8399
Services Offered
In-center hemodialysis

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CLOVE LAKES SNF OPERATIONS LLC
Skilled Nursing Facility
25 FANNING ST
STATEN ISLAND, NY 10314
Richmond County (718) 289-7900
N/A
Clinic/Center (Physical Therapy)
25 FANNING ST
STATEN ISLAND, NY 10314
Richmond County (718) 698-2475
WURAOLA ISMAILA
Registered Nurse
25 FANNING ST
STATEN ISLAND, NY 10314
Richmond County (718) 289-7900
MRS. SUMA MARIAM KURIAKOSE PT, DPT
Physical Therapist
25 FANNING ST
STATEN ISLAND, NY 10314
Richmond County (718) 289-7019
CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER, INC.
Skilled Nursing Facility
25 FANNING ST
STATEN ISLAND, NY 10314
Richmond County (718) 289-7900
CLOVE LAKES REHABILITATION AND OUTPATIENT SERVICES
Physical Therapist
25 FANNING ST
STATEN ISLAND, NY 10314
Richmond County (718) 289-7878
BRIANNA ROSE MARFA CCC-SLP
Speech-Language Pathologist
25 FANNING ST
STATEN ISLAND, NY 10314
Richmond County (718) 289-7900
MR. JOHN THOMAS
Physical Therapist
25 FANNING ST
STATEN ISLAND, NY 10314
Richmond County (718) 289-7004

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Island Rehabilitative Services Corp's NPI number?

The NPI number for Island Rehabilitative Services Corp is 1669453502. It was assigned to this organization in the NPPES registry on November 8, 2005.

Where is Island Rehabilitative Services Corp located?

Island Rehabilitative Services Corp is located at 25 Fanning St, Staten Island, NY 10314. The listed phone number is (347) 671-8399.

What is Island Rehabilitative Services Corp's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Is Island Rehabilitative Services Corp a Medicare-certified dialysis facility?

Yes. FMC - Island Rehabilitative Services-Clove Lakes Extension is a Medicare-certified dialysis facility, certified since November 7, 2003.

What quality rating does Island Rehabilitative Services Corp have?

CMS rates FMC - Island Rehabilitative Services-Clove Lakes Extension 2 out of 5 stars on Care Compare. The full measure detail is in the Dialysis Facility Quality section above.

When was this NPI record last updated?

The NPPES record for Island Rehabilitative Services Corp was last updated on September 28, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.