Provider Demographics
NPI:1558338806
Name:NEW YORK NEPHROLOGY AND DIALYSIS ACCESS SURGERY, P.C.
Entity Type:Organization
Organization Name:NEW YORK NEPHROLOGY AND DIALYSIS ACCESS SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-434-2244
Mailing Address - Street 1:62 HACKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1718
Mailing Address - Country:US
Mailing Address - Phone:518-434-2244
Mailing Address - Fax:518-434-4659
Practice Address - Street 1:62 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1718
Practice Address - Country:US
Practice Address - Phone:518-434-2244
Practice Address - Fax:518-434-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00372289Medicaid
33788AMedicare ID - Type Unspecified