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General NPI Number Information
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NPI Number | 1245235902
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE DIALYSIS CENTER OF WESTERN NEW YORK, INC.
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 6010 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6837
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Country | US
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Telephone | 716-631-4700
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Fax | 716-631-4711
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Provider Business Mailing Address
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Address Line | 6010 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6837
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Country | US
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Telephone | 716-631-4700
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Fax | 716-631-4711
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ROMESH KOHLI
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Credential | M.D.
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Telephone | 716-631-4700
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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 | 121592-1
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License Number State | NY
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Taxonomy #2
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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 | 144330-1
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License Number State | NY
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