Organization · Type 2 NPI

Knickerbocker Dialysis Inc

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Staten Island, NY

NPI number 1366876948 Active

Practice location

1139 Hylan Blvd
Staten Island, NY 10305-2061

Call (718) 816-4913 Map

Fax (718) 816-6340

Mailing address

5200 Virginia Way, L & C Dept
Brentwood, TN 37027-7569

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	7000272R (NY)

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

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NPI record

NPI: 1366876948
Entity type: Organization (Type 2)
Issued: Aug 30, 2013
Last updated: Feb 29, 2024
Status: Active

Other names

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Staten Island Dialysis Center · doing business as
Staten Island Dialysis Center · doing business as

Authorized official

Samuel Wey
VP, Licensure & Certification
(615) 341-6641

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1366876948

Knickerbocker Dialysis Inc's National Provider Identifier is 1366876948, issued on Aug 30, 2013. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Staten Island, NY. The record was last updated on Feb 29, 2024.