MEDICARE: DAVITA OF NEW YORK 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

General Provider Information

NPI Number	:	1073778379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVITA OF NEW YORK INC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	STE 400 L&C
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4521
Fax Number	:	866-594-2894

Provider Business Practice Location Address
First Line	:	1305 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5911
Country	:	US
Telephone Number	:	718-629-3900
Fax Number	:	718-629-6315

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JIM HILGER
Credential	:
Telephone Number	:	253-382-1919

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	07/25/2008

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