Organization
GREEN MANOR DIALYSIS CENTER LLC
Active
Other names
East Greenbush Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD FOURNIER RN,CNN (DIRECTOR OF DIALYSIS SERVICES)
(518) 828-0717
Entity
Organization
Contact information
Practice address
583 COLUMBIA TPKE, EAST GREENBUSH, NY 12061-1602
(518) 477-4370
(518) 477-4319
Mailing address
583 COLUMBIA TPKE, EAST GREENBUSH, NY 12061-1602
(518) 477-4370
(518) 477-4319
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
1059202R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01687094
—
NY
Enumeration date
04/21/2016
Last updated
05/24/2016
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