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	:	1730676743
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	:	1820 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-3131
Country	:	US
Telephone Number	:	718-824-0245
Fax Number	:	718-824-1775

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	SAMUEL WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	01/12/2026

Similar Medicare Providers

1114974623 — LUIS MARIO ASTUDILLO MD
Practice Location Address:

3131 GRAND CONCOURSE , SUITE 1B
BRONX, NY
10468-1442

Practice Phone: 718-295-7900
Practice Fax: 718-295-4160

1285734855 — DR. CARY SCOTT POLLACK M.D.
Practice Location Address:

3131 GRAND CONCOURSE
BRONX, NY
10468-1442

Practice Phone: 718-295-7900
Practice Fax: 212-781-0513

1174726855 — CARDIOLOGY UNLIMITED PC
Practice Location Address:

3131 GRAND CONCOURSE , SUITE 1B
BRONX, NY
10468-1442

Practice Phone: 718-295-7900
Practice Fax: 718-295-4160

1518140904 — JOHN BAGLIONI RD
Practice Location Address:

3131 GRAND CONCOURSE APT 9A
BRONX, NY
10468-1411

Practice Phone: 718-219-6069
Practice Fax:

1780835074 — REBECCA ANN FOWLES OT
Practice Location Address:

3131 GRAND CONCOURSE APT 3C
BRONX, NY
10468-1404

Practice Phone: 718-584-5130
Practice Fax: 718-584-5130

1154564292 — MISS LINDA KAROL CADAVID M.A., CCC-SLP
Practice Location Address:

3131 FAIRFIELD AVE
BRONX, NY
10463-3201

Practice Phone: 646-236-9862
Practice Fax: 347-275-3574

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.