Provider Demographics
NPI:1851500813
Name:REGIONAL NEPHROLOGY PLLC
Entity Type:Organization
Organization Name:REGIONAL NEPHROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-294-0994
Mailing Address - Street 1:30 HATFIELD LN
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6766
Mailing Address - Country:US
Mailing Address - Phone:845-294-0994
Mailing Address - Fax:845-615-1376
Practice Address - Street 1:30 HATFIELD LN
Practice Address - Street 2:SUITE 208
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6766
Practice Address - Country:US
Practice Address - Phone:845-294-0994
Practice Address - Fax:845-615-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEQ021Medicare PIN