Provider Demographics
NPI:1073919387
Name:VESTAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:VESTAL HEALTHCARE, LLC
Other - Org Name:LINDENHURST DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-816-6505
Mailing Address - Street 1:185 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4505
Mailing Address - Country:US
Mailing Address - Phone:631-956-6060
Mailing Address - Fax:631-956-6070
Practice Address - Street 1:185 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4505
Practice Address - Country:US
Practice Address - Phone:631-956-6060
Practice Address - Fax:631-956-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2015-04-16
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
NY333541Medicare Oscar/Certification