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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 : 1699166926
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 : 4102 13TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-1389
Country : US
Telephone Number : 718-435-2112
Fax Number : 718-435-0354
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : SAMUEL WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 02/09/2015
Last Update Date : 04/08/2025

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Directions to “KNICKERBOCKER DIALYSIS INC ” Practice Location

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