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General NPI Number Information
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NPI Number | 1275595571
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Entity Type | Organization
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Legal Business Name | HORTENSE & LOUIS RUBIN DIALYSIS CENTER, INC.
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 59C MYRTLE ST
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-1012
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Country | US
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Telephone | 518-587-1919
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Fax | 518-587-1313
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Provider Business Mailing Address
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Address Line | 59C MYRTLE ST
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-1012
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Country | US
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Telephone | 518-587-1919
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Fax | 518-587-1313
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WAYNE A EVANCOE
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Credential | CEO
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Telephone | 518-271-0702
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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 | 4102201R
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License Number State | NY
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