| Organization Name: | MOUNT VERNON DIALYSIS LLC |
| NPI Number: | 1013107358 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER OBHOKHAN ADUBOR (MEDICAL DIRECTOR) |
| Mailing Address: | 12 N 7th Avenue 3rd Floor Mount Vernon |
| State: | NY US |
| Postal Code: | 105502026 |
| Phone Number: | 9146654343 |
| Fax Number: | 9146652982 |
| NPI Enumeration Date: | 08/01/2007 |
| NPI Last Update Date: | 11/11/2008 |
| 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: | |