Healthcare Provider Details

I. General information

NPI: 1215464987
Provider Name (Legal Business Name): DIALYSIS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 COLUMBIA TPKE
EAST GREENBUSH NY
12061-1602
US

IV. Provider business mailing address

1850 PEOPLES AVE
TROY NY
12180-3607
US

V. Phone/Fax

Practice location:
  • Phone: 518-477-4217
  • Fax:
Mailing address:
  • Phone: 518-571-0702
  • Fax: 518-271-0624

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: MR. DONOVAN SCHULTZ
Title or Position: PRESIDENT
Credential:
Phone: 615-327-3061