Healthcare Provider Details

I. General information

NPI: 1760647150
Provider Name (Legal Business Name): DAVITA OF NEW YORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DATES DR STE 206
ITHACA NY
14850-1345
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400 L&C
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-1693
  • Fax: 607-273-5580
Mailing address:
  • Phone: 615-320-4521
  • Fax: 866-594-2894

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: JIM HILGER
Title or Position: VICE PRESIDENT
Credential:
Phone: 253-382-1919