Provider Demographics
NPI:1598839540
Name:RENAL CARE OF NORTHERN NEW YORK, LLC
Entity Type:Organization
Organization Name:RENAL CARE OF NORTHERN NEW YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-282-2200
Mailing Address - Street 1:3510 HYDE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-2204
Mailing Address - Country:US
Mailing Address - Phone:716-282-2200
Mailing Address - Fax:
Practice Address - Street 1:19320 WASHINGTON STREET
Practice Address - Street 2:SUITE II
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:716-282-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
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
NY332653Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER