DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: KNICKERBOCKER DIALYSIS INC

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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1679517270
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 : 1366 VICTORY BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-3907
Country : US
Telephone Number : 718-816-6200
Fax Number : 718-816-6235
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : SAMUEL WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 06/15/2006
Last Update Date : 06/01/2026

Similar Medicare Providers

1740285238 — NICOLAS C LANSIGAN JR. MD
Practice Location Address:
1366 VICTORY BLVD , RICHMOND SURGICAL ASSOCIATES PLLC
STATEN ISLAND, NY
10301-3907
Practice Phone: 718-442-4777
Practice Fax: 718-273-6635
1619978442 — DR. THOMAS JOSEPH FORLENZA MD
Practice Location Address:
1366 VICTORY BLVD
STATEN ISLAND, NY
10301-3907
Practice Phone: 718-816-4949
Practice Fax: 718-273-5504
1083692727 — DR. MEILIN ZHANG MD
Practice Location Address:
1366 VICTORY BLVD
STATEN ISLAND, NY
10301-3907
Practice Phone: 718-273-3400
Practice Fax: 718-727-3402
1891773099 — DR. EUGENE PETRA MD
Practice Location Address:
1366 VICTORY BLVD
STATEN ISLAND, NY
10301-3907
Practice Phone: 718-273-3400
Practice Fax: 718-727-3402
1013995190 — DR. JUDITH MCLOUGHLIN MD
Practice Location Address:
1366 VICTORY BLVD
STATEN ISLAND, NY
10301-3907
Practice Phone: 718-273-3400
Practice Fax: 718-727-3402
1558349639 — DR. BERTRAM ALPERT MD
Practice Location Address:
1366 VICTORY BLVD
STATEN ISLAND, NY
10301-3907
Practice Phone: 718-273-3400
Practice Fax: 718-727-3402

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.