Healthcare Provider Details

I. General information

NPI: 1861432304
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES OF WATERTOWN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19316 US ROUTE 11 STE B
WATERTOWN NY
13601-6735
US

IV. Provider business mailing address

19316 US ROUTE 11 STE B
WATERTOWN NY
13601-6736
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-0136
  • Fax: 315-782-7212
Mailing address:
  • Phone: 315-782-0136
  • Fax: 315-782-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KHALID P SINDHU
Title or Position: OWNER
Credential: MD
Phone: 315-782-0136