Provider Demographics
NPI:1003210915
Name:NEW YORK DIALYSIS SERVICES, INC.
Entity Type:Organization
Organization Name:NEW YORK DIALYSIS SERVICES, INC.
Other - Org Name:FREEDOM CENTER OF ROCHESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:100 MERIDIAN CENTRE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3926
Mailing Address - Country:US
Mailing Address - Phone:585-241-9783
Mailing Address - Fax:585-241-3430
Practice Address - Street 1:100 MERIDIAN CENTRE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3926
Practice Address - Country:US
Practice Address - Phone:585-241-9783
Practice Address - Fax:585-241-3430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-21
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04317433Medicaid
NY332723Medicare Oscar/Certification