Healthcare Provider Details

I. General information

NPI: 1346572153
Provider Name (Legal Business Name): LSL NEWBURGH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAUREL AVE STE 101
CORNWALL NY
12518-1403
US

IV. Provider business mailing address

19 LAUREL AVE STE 101
CORNWALL NY
12518-1403
US

V. Phone/Fax

Practice location:
  • Phone: 845-534-9820
  • Fax: 845-534-9825
Mailing address:
  • Phone: 845-534-9820
  • Fax: 845-534-9825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARRY L. BLANTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-699-9000