MEDICARE: NEW YORK DIALYSIS SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003210915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK DIALYSIS SERVICES, INC.

Provider Business Mailing Address
First Line	:	100 MERIDIAN CENTRE BLVD STE 130
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3926
Country	:	US
Telephone Number	:	585-241-9783
Fax Number	:	585-241-3430

Provider Business Practice Location Address
First Line	:	100 MERIDIAN CENTRE BLVD STE 130
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3926
Country	:	US
Telephone Number	:	585-241-9783
Fax Number	:	585-241-3430

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BARRY L. BLANTON
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	10/19/2023

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