Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
Sandford Boulevard Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
120 E SANDFORD BLVD, MOUNT VERNON, NY 10550-4512
(914) 665-2035
(914) 667-5126
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6410
(888) 662-8259
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
—
05707391
—
NY
Enumeration date
02/18/2018
Last updated
12/28/2023
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