1265798292 NPI number — RENAL CARE OF ROCKLAND, INC

Table of content: (NPI 1265798292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265798292 NPI number — RENAL CARE OF ROCKLAND, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAL CARE OF ROCKLAND, 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:
D/B/A/ RENAL CARE OF SUFFERN
Provider Other Organization Name Type Code:
3
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:
1265798292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 ROUTE 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY COTTAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10989-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-268-2777
Provider Business Mailing Address Fax Number:
845-268-7198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 ROUTE 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10901-4811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-357-0452
Provider Business Practice Location Address Fax Number:
845-357-3860
Provider Enumeration Date:
04/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MORIBER
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
305-632-5574

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , 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)





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