MEDICARE: KNICKERBOCKER DIALYSIS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245731876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNICKERBOCKER DIALYSIS INC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 SNEDEN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3637
Country	:	US
Telephone Number	:	718-356-2678
Fax Number	:	718-356-6376

Authorized Official
Title or Position	:	VP, LICENSURE & CERTIFICATION
Name	:	SAMUEL T WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/24/2025

Similar Medicare Providers

1649500992 — NATALIYA VINOKUR M.S/B.S IN OT
Practice Location Address:

25 BAY TER , 14 B
STATEN ISLAND, NY
10306-3637

Practice Phone: 917-318-4798
Practice Fax:

1780516997 — AMBERLIZ E LINARES RN
Practice Location Address:

67 ARDEN AVE
STATEN ISLAND, NY
10312-1206

Practice Phone: 347-753-2935
Practice Fax:

1285566497 — GIANNA BIDETTO
Practice Location Address:

115 SERRELL AVE
STATEN ISLAND, NY
10312-3413

Practice Phone: 917-693-2718
Practice Fax:

1972436343 — NAZIRA KARIMOVA
Practice Location Address:

624 DRUMGOOLE RD E
STATEN ISLAND, NY
10312-3308

Practice Phone: 917-907-4703
Practice Fax:

1326970666 — ZANDA OCHIROVA
Practice Location Address:

156 PETRUS AVE # F1
STATEN ISLAND, NY
10312-3735

Practice Phone: 917-868-0186
Practice Fax:

1659204717 — AMANDA ANN GIUDICE
Practice Location Address:

200 NEDRA PL
STATEN ISLAND, NY
10312-1736

Practice Phone: 718-984-9800
Practice Fax:

Directions to “KNICKERBOCKER DIALYSIS INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.