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General NPI Number Information
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NPI Number | 1548287329
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Entity Type | Organization
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Legal Business Name | MOHAWK VALLEY NEPHROLOGY ASSOCIATES, LLP
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 125 BUSINESS PARK DR STE 150
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City | UTICA
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State | NY
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Zip | 13502-6322
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Country | US
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Telephone | 315-735-3541
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Fax | 315-724-3255
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Provider Business Mailing Address
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Address Line | 125 BUSINESS PARK DR STE 150
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City | UTICA
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State | NY
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Zip | 13502-6322
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Country | US
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Telephone | 315-735-3541
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Fax | 315-724-3255
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. LORRAINE A LANE
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Credential |
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Telephone | 315-724-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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