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
100 WOODS RD, MACY PAVILLION, 2ND FLOOR, ROOM 240, VALHALLA, NY 10595-1530
(914) 493-1160
(914) 493-8692
Mailing address
234 TARRYTOWN RD, ELMSFORD, NY 10523-3423
(914) 592-5858
(914) 592-1595
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
5957201R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03010464
—
NY
Enumeration date
07/27/2006
Last updated
10/05/2023
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