| Green Manor Dialysis Center Llc | |
|
30 Whittier Way Ghent NY 12075 | |
| (518) 828-0717 | |
| (517) 822-0776 |
| Full Name | Green Manor Dialysis Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 30 Whittier Way, Ghent, New York |
| Authorized Official Name and Position | Vinny Anand (CEO) |
| Authorized Official Contact | 5188280717 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Manor Dialysis Center Llc 30 Whittier Way Ghent NY 12075 Ph: (518) 828-0717 | Green Manor Dialysis Center Llc 30 Whittier Way Ghent NY 12075 Ph: (518) 828-0717 |
| NPI Number | 1467445601 |
|---|---|
| Provider Enumeration Date | 08/23/2005 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7315854064 |
|---|---|
| Medicare Enrollment ID | O20020927000001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467445601 | NPI | - | NPPES |
| 01687094 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1059202R (New York) | Primary |
Your Family Doc, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2 Sherman Potts Dr, Ghent, NY 12075 Phone: 518-314-0889 Fax: 518-244-8812 |