Provider Demographics
NPI:1013107358
Name:MOUNT VERNON DIALYSIS LLC
Entity Type:Organization
Organization Name:MOUNT VERNON DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:OBHOKHAN
Authorized Official - Last Name:ADUBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-665-4343
Mailing Address - Street 1:12 N 7TH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2026
Mailing Address - Country:US
Mailing Address - Phone:914-665-4343
Mailing Address - Fax:914-665-2982
Practice Address - Street 1:12 N 7TH AVENUE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2026
Practice Address - Country:US
Practice Address - Phone:914-665-4343
Practice Address - Fax:914-665-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-11-11
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
NY332661Medicare Oscar/Certification