Provider Demographics
NPI:1134289234
Name:CARILLON DIALYSIS, LLC
Entity type:Organization
Organization Name:CARILLON DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-271-5800
Mailing Address - Street 1:830 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4543
Mailing Address - Country:US
Mailing Address - Phone:631-630-0398
Mailing Address - Fax:631-630-0399
Practice Address - Street 1:830 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4543
Practice Address - Country:US
Practice Address - Phone:631-271-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment