Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
Melrose Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
459 E 149TH ST, BRONX, NY 10455-1314
(718) 585-4951
(718) 292-9823
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
7000272R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04934992
—
NY
Enumeration date
04/18/2016
Last updated
11/01/2024
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