1245235902 NPI number — COMPREHENSIVE DIALYSIS CENTER OF WESTERN NEW YORK, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245235902 NPI number — COMPREHENSIVE DIALYSIS CENTER OF WESTERN NEW YORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE DIALYSIS CENTER OF WESTERN NEW YORK, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245235902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6010 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-6837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-631-4700
Provider Business Mailing Address Fax Number:
716-631-4711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6010 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-6837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-631-4700
Provider Business Practice Location Address Fax Number:
716-631-4711
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KOHLI
Authorized Official First Name:
ROMESH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
716-631-4700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  121592-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0700X , with the licence number: 144330-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B4 . This is a "IHA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01502987 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00011420401 . This is a "UNIVERA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 359 . This is a "BSBSWNY PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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