Organization
KNICKERBOCKER DIALYSIS INC
Active
Parent organization
DAVITA INC
Other names
Conduit Avenue Dialysis
Organization subpart
Yes
Provider details
NPI number
Legal business name
DAVITA INC
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(615) 320-4414
Entity
Organization
Contact information
Practice address
21910 S CONDUIT AVE, SPRINGFIELD GARDENS, NY 11413-3462
(718) 341-0107
(718) 341-2255
Mailing address
5200 VIRGINIA WAY, L AND C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4414
(866) 865-2884
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
04/09/2020
Last updated
04/09/2020
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