Organization
VESTAL HEALTHCARE, LLC
Active
Other names
Long Island Bay Shore Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E. CAPUTO (MEMBER)
(206) 816-6505
Entity
Organization
Contact information
Practice address
929 SUNRISE HWY, BAY SHORE, NY 11706-5907
(631) 224-8500
(631) 224-8503
Mailing address
929 SUNRISE HWY, BAY SHORE, NY 11706-5907
(631) 224-8500
(631) 224-8503
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04240997
—
NY
Enumeration date
11/13/2014
Last updated
04/14/2016
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