Hortense & Louis Rubin Dialysis Center, Inc.

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

4102201R Issued in NY

Legal business name

HORTENSE & LOUIS RUBIN DIALYSIS CENTER, INC.

Practice address

21 Crossing Blvd
Clifton Park, NY 12065-4181

Phone

(518) 831-6700

Fax

(518) 831-6710

NPI assigned

Apr 27, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Wayne A Evancoe, CEO

Title

Administrator

Phone

(518) 271-0702

Specialties & licenses 1

Addresses

Other identifiers 6

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851358469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CROSSING BLVD",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120654181",
            "telephone_number": "518-831-6700",
            "fax_number": "518-831-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 CROSSING BLVD",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120654181",
            "telephone_number": "518-831-6700",
            "fax_number": "518-831-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HORTENSE & LOUIS RUBIN DIALYSIS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EVANCOE",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "518-271-0702",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "4102201R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00964250",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EBCBS",
            "identifier": "026966",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10005842",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "85540",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC/EMPIRE PLAN",
            "identifier": "332632",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSNENY",
            "identifier": "000400438003",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Clifton Park, NY
• Providers in Clifton Park, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.