Green Manor Dialysis Center LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

1059202R Issued in NY

Legal business name

GREEN MANOR DIALYSIS CENTER LLC

Doing business as

DBA Columbia-Greene Dialysis Centers

Practice address

30 Whittier Way
Ghent, NY 12075

Phone

(518) 828-0717

Fax

(517) 822-0776

NPI assigned

Aug 23, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vinny Anand, MD

Title

Ceo

Phone

(518) 828-0717

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DBA Columbia-Greene Dialysis Centers Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Green Manor Dialysis Center LLC

  dba Northern Hudson Valley Dialysis Center

  • Clinic/Center
  • Catskill, NY
  • NPI 1912991266

  7315854064

  Same PAC ID

Tax ID family

Green Manor Dialysis Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Green Manor Dialysis Center LLC

  dba Northern Hudson Valley Dialysis Center

  • Clinic/Center
  • Catskill, NY
  • NPI 1912991266
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467445601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 WHITTIER WAY",
            "city": "GHENT",
            "state": "NY",
            "postal_code": "12075",
            "telephone_number": "518-828-0717",
            "fax_number": "517-822-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 WHITTIER WAY",
            "city": "GHENT",
            "state": "NY",
            "postal_code": "12075",
            "telephone_number": "518-828-0717",
            "fax_number": "517-822-0776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN MANOR DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANAND",
        "authorized_official_first_name": "VINNY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "518-828-0717",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": "1059202R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01687094",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA Columbia-Greene Dialysis Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jill Edelstein, LCSW
• Christine Lynn Ewasick
• Flex Care, LLC (Flex Rehab)
• Eden G Fromberg, DO
• Galr Operating, LLC (Ghent Assisted Living)
• GRNC Operating LLC (Ghent Rehabilitation & Nursing Center)
• Lynn Marie Hart, MS, RDN, CDN
• Heart of Space LCSW PLLC
• Ijunanya Holder, DPT
• Hudson Care Physical Therapy PLLC

• Clinic/Center in Ghent, NY
• Providers in Ghent, NY by specialty
• Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.