Provider Demographics
NPI:1952382582
Name:EASTVIEW DIALYSIS, INC.
Entity type:Organization
Organization Name:EASTVIEW DIALYSIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-742-1250
Mailing Address - Street 1:120 VICTOR HEIGHTS PKWY
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8934
Mailing Address - Country:US
Mailing Address - Phone:585-742-1250
Mailing Address - Fax:585-472-1951
Practice Address - Street 1:120 VICTOR HEIGHTS PKWY
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-8934
Practice Address - Country:US
Practice Address - Phone:585-742-1250
Practice Address - Fax:585-472-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYOP. CERT.# 3464201R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01900292Medicaid
NY01900292Medicaid