Provider Demographics
NPI:1912175621
Name:NICHOLAS H. NOYES MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:NICHOLAS H. NOYES MEMORIAL HOSPITAL
Other - Org Name:NOYES CENTER FOR KIDNEY DISEASE AND DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNOSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-335-6001
Mailing Address - Street 1:4616 MILLLENIUM DR
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454
Mailing Address - Country:US
Mailing Address - Phone:585-991-5105
Mailing Address - Fax:
Practice Address - Street 1:4616 MILLLENIUM DR
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-991-5105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY333553Medicare PIN