Provider Demographics
NPI:1144325945
Name:NEW YORK DIALYSIS SERVICES, INC.
Entity type:Organization
Organization Name:NEW YORK DIALYSIS SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:2615 FREDERICK DOUGLASS BLVD
Mailing Address - Street 2:#2621
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1705
Mailing Address - Country:US
Mailing Address - Phone:212-281-8200
Mailing Address - Fax:212-690-7265
Practice Address - Street 1:2615 FREDERICK DOUGLAS BLVD
Practice Address - Street 2:#2621
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1705
Practice Address - Country:US
Practice Address - Phone:212-281-8200
Practice Address - Fax:212-690-7265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-14
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
332564Medicare Oscar/Certification