Organization · Type 2 NPI

Knickerbocker Dialysis Inc

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

NPI number 1629617576 Active

Practice location

1633 Route 202 Ste 120
Pomona, NY 10970-2926

Call (845) 364-9101 Map

Fax (845) 364-9106

Mailing address

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

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	None listed

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

NPI record

NPI: 1629617576
Entity type: Organization (Type 2)
Issued: Dec 24, 2019
Last updated: Nov 10, 2023
Status: Active

Other names

<unavail>
Half Moon Dialysis · doing business as
Half Moon Dialysis · doing business as

Authorized official

Samuel Wey
VP Licensure & Certification
(615) 341-6410

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About NPI 1629617576

Knickerbocker Dialysis Inc's National Provider Identifier is 1629617576, issued on Dec 24, 2019. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Pomona, NY. The record was last updated on Nov 10, 2023.