Provider Demographics
NPI:1114663127
Name:NORWALK DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:NORWALK DIALYSIS CENTER LLC
Other - Org Name:CASSENA KIDNEY CARE AT NORWALK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-422-7817
Mailing Address - Street 1:225 CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2083
Mailing Address - Country:US
Mailing Address - Phone:516-422-7817
Mailing Address - Fax:631-792-1341
Practice Address - Street 1:23 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3705
Practice Address - Country:US
Practice Address - Phone:203-853-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment