Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
Staten Island South Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
30 SNEDEN AVE, STATEN ISLAND, NY 10312-3637
(718) 356-2678
(718) 356-6376
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05821045
—
NY
Enumeration date
02/28/2018
Last updated
02/24/2025
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