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General NPI Number Information
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NPI Number | 1598839540
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Entity Type | Organization
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Legal Business Name | RENAL CARE OF NORTHERN NEW YORK, LLC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 19320 WASHINGTON STREET SUITE II
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City | WATERTOWN
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State | NY
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Zip | 13601
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Country | US
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Telephone | 716-282-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 HYDE PARK BLVD
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City | NIAGARA FALLS
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State | NY
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Zip | 14305-2204
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Country | US
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Telephone | 716-282-2200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL SLOMA
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Credential |
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Telephone | 716-282-2200
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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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