Healthcare Provider Details

I. General information

NPI: 1245235902
Provider Name (Legal Business Name): COMPREHENSIVE DIALYSIS CENTER OF WESTERN NEW YORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 MAIN ST
WILLIAMSVILLE NY
14221-6837
US

IV. Provider business mailing address

6010 MAIN ST
WILLIAMSVILLE NY
14221-6837
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-4700
  • Fax: 716-631-4711
Mailing address:
  • Phone: 716-631-4700
  • Fax: 716-631-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number121592-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number144330-1
License Number StateNY

VIII. Authorized Official

Name: DR. ROMESH KOHLI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 716-631-4700