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Davita Of New York INC

Clinic/Center, End-Stage Renal Disease (ESRD) Treatment in Medford, NY. Organization (NPI-2).

NPI number1265697692
StatusActive
Last updated in NPPESJul 24, 2008

Details

NPI
1265697692
Entity type
Organization (NPI-2)
Legal business name
Davita Of New York INC
Organization subpart
No
Enumeration date
Jul 24, 2008
Last updated
Jul 24, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment––Yes

Other names

  • Medford Kidney Center (Doing Business As)

Practice location

1725 N Ocean Ave
Medford, NY 11763-2649

Phone 631-289-8000 · Fax 631-289-8079

Mailing address

5200 Virginia Way
Ste 400 L&C
Brentwood, TN 37027-7569

Phone 615-320-4521 · Fax 866-594-2894

Authorized official

Jim Hilger
Vice President
2533821919

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