Provider Demographics
NPI:1245235902
Name:COMPREHENSIVE DIALYSIS CENTER OF WESTERN NEW YORK, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE DIALYSIS CENTER OF WESTERN NEW YORK, INC.
Other - Org Name:CDCWNY
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-631-4700
Mailing Address - Street 1:6010 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6837
Mailing Address - Country:US
Mailing Address - Phone:716-631-4700
Mailing Address - Fax:716-631-4711
Practice Address - Street 1:6010 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6837
Practice Address - Country:US
Practice Address - Phone:716-631-4700
Practice Address - Fax:716-631-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121592-1261QE0700X
NY144330-1261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB4OtherIHA PROVIDER NUMBER
NY01502987Medicaid
NY00011420401OtherUNIVERA PROVIDER NUMBER
NY359OtherBSBSWNY PROVIDER NUMBER
NYC49517Medicare UPIN
NY359OtherBSBSWNY PROVIDER NUMBER