Healthcare Provider Details

I. General information

NPI: 1952382582
Provider Name (Legal Business Name): EASTVIEW DIALYSIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 VICTOR HEIGHTS PKWY
VICTOR NY
14564-8934
US

IV. Provider business mailing address

120 VICTOR HEIGHTS PKWY
VICTOR NY
14564-8934
US

V. Phone/Fax

Practice location:
  • Phone: 585-742-1250
  • Fax: 585-472-1951
Mailing address:
  • Phone: 585-742-1250
  • Fax: 585-472-1951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOP. CERT.# 3464201R
License Number StateNY

VIII. Authorized Official

Name: LORI SPALDING
Title or Position: ADMINISTRATOR
Credential:
Phone: 585-742-1250