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General NPI Number Information
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NPI Number | 1013107358
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Entity Type | Organization
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Legal Business Name | MOUNT VERNON DIALYSIS LLC
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 12 N 7TH AVENUE 3RD FLOOR
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2026
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Country | US
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Telephone | 914-665-4343
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Fax | 914-665-2982
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Provider Business Mailing Address
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Address Line | 12 N 7TH AVE 3RD FLOOR
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2026
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Country | US
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Telephone | 914-665-4343
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Fax | 914-665-2982
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CHRISTOPHER OBHOKHAN ADUBOR
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Credential | MD
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Telephone | 914-665-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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