Basic Information
| Provider Information | |||||||||
| NPI: | 1811621170 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK DIALYSIS SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3160 WEBSTER AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104675065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816999000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3160 WEBSTER AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104675065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816999000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2022 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | BLANTON | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2144453010 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FRESENIUS MEDICAL CARE HOLDINGS, INC. | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.