Organization
DIALYSIS CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONOVAN SCHULTZ (PRESIDENT)
(615) 327-3061
Entity
Organization
Contact information
Practice address
180W 3RD ST, OSWEGO, NY 13126
(315) 342-3045
(315) 342-3491
Mailing address
1127 E GENESEE ST, SYRACUSE, NY 13210-1911
(315) 473-5100
(315) 473-6037
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
3301213R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01367239
—
NY
05
—
03007861
—
NY
Enumeration date
07/14/2006
Last updated
10/04/2023
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