Healthcare Provider Details

I. General information

NPI: 1164165304
Provider Name (Legal Business Name): MVNY PARTNERS IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 PERIMETER RD
ROME NY
13441-4018
US

IV. Provider business mailing address

PO BOX 631725
CINCINNATI OH
45263-1725
US

V. Phone/Fax

Practice location:
  • Phone: 315-334-4786
  • Fax:
Mailing address:
  • Phone: 315-334-4786
  • Fax:

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: THOMAS L WEINBERG
Title or Position: CHAIRMAN & PRESIDENT
Credential:
Phone: 214-736-2700