Healthcare Provider Details

I. General information

NPI: 1548287329
Provider Name (Legal Business Name): MOHAWK VALLEY NEPHROLOGY ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BUSINESS PARK DR STE 150
UTICA NY
13502-6322
US

IV. Provider business mailing address

125 BUSINESS PARK DR STE 150
UTICA NY
13502-6322
US

V. Phone/Fax

Practice location:
  • Phone: 315-735-3541
  • Fax: 315-724-3255
Mailing address:
  • Phone: 315-735-3541
  • Fax: 315-724-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORRAINE A LANE
Title or Position: BILLING MANAGER
Credential:
Phone: 315-724-3880