Provider Demographics
NPI:1548287329
Name:MOHAWK VALLEY NEPHROLOGY ASSOCIATES, LLP
Entity type:Organization
Organization Name:MOHAWK VALLEY NEPHROLOGY ASSOCIATES, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-724-3880
Mailing Address - Street 1:125 BUSINESS PARK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6322
Mailing Address - Country:US
Mailing Address - Phone:315-735-3541
Mailing Address - Fax:315-724-3255
Practice Address - Street 1:125 BUSINESS PARK DR STE 150
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6322
Practice Address - Country:US
Practice Address - Phone:315-735-3541
Practice Address - Fax:315-724-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDC5232OtherRAILROAD MEDICARE
NYDC5232OtherRAILROAD MEDICARE