Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
Rockland County 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
203 W ROUTE 59, NANUET, NY 10954-2218
(845) 501-7590
(845) 501-7585
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
—
05882568
—
NY
Enumeration date
05/29/2019
Last updated
05/07/2024
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