Organization
CENTRAL NEW YORK DC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERBERT S LAWSON (CFO)
(303) 785-7521
Entity
Organization
Contact information
Practice address
910 ERIE BLVD E, SYRACUSE, NY 13210-1060
(315) 410-8040
(315) 410-8030
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
3301217R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02300801
—
NY
01
—
97005
MVP PROVIDER NUMBER
NY
Enumeration date
11/14/2006
Last updated
11/03/2011
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