| Organization Name: | VESTAL HEALTHCARE, LLC |
| NPI Number: | 1003239062 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK E CAPUTO (MANAGER) |
| Mailing Address: | 52 S Union Rd Williamsville |
| State: | NY US |
| Postal Code: | 142216509 |
| Phone Number: | 5856940308 |
| Fax Number: | 5854245122 |
| NPI Enumeration Date: | 01/28/2014 |
| NPI Last Update Date: | 04/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |