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General NPI Number Information
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NPI Number | 1912991266
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Entity Type | Organization
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Legal Business Name | GREEN MANOR DIALYSIS CENTER LLC
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 159 JEFFERSON HTS
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City | CATSKILL
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State | NY
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Zip | 12414-1237
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Country | US
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Telephone | 518-943-1404
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Fax | 518-943-2602
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Provider Business Mailing Address
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Address Line | 159 JEFFERSON HTS
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City | CATSKILL
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State | NY
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Zip | 12414-1237
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Country | US
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Telephone | 518-943-1404
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Fax | 518-943-2602
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Authorized Official
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Title or Position | CEO MEDICAL DIRECTOR
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Name | VINNY ANAND
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Credential | MD
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Telephone | 518-943-1404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1059202R
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License Number State | NY
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