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Organization

WESTERN NEW YORK DC, LLC

Active
Other names
Suburban Dialysis Center
Organization subpart
No

Provider details

NPI number
Authorized official
HERBERT S LAWSON (CFO)
(303) 785-7521
Entity
Organization

Contact information

Practice address
1542 MAPLE RD, WILLIAMSVILLE, NY 14221-3625
(716) 636-3300
(716) 636-1893
Mailing address
2100 CENTRAL AVE, SUITE 201, BOULDER, CO 80301-2838
(303) 785-7523

Taxonomy

Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
1401229R
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000378001
BLUE CROSS PROVIDER NUMBE
NY
05
01984981
NY
Enumeration date
11/21/2006
Last updated
08/22/2020
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