Organization
HORTENSE & LOUIS RUBIN DIALYSIS CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE A EVANCOE CEO (ADMINISTRATOR)
(518) 271-0702
Entity
Organization
Contact information
Practice address
1850 PEOPLES AVE, TROY, NY 12180-3607
(518) 271-0702
(518) 271-0624
Mailing address
1850 PEOPLES AVE, TROY, NY 12180-3607
(518) 271-0702
(518) 271-0624
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
4102201R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000400438001
BSNENY
NY
01
—
005376
EBCBS
NY
05
—
00964250
—
NY
01
—
10005842
CDPHP
NY
01
—
953252
MVP
NY
Enumeration date
03/28/2006
Last updated
07/20/2007
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