Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
Half Moon Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6410
Entity
Organization
Contact information
Practice address
1633 ROUTE 202 STE 120, POMONA, NY 10970-2926
(845) 364-9101
(845) 364-9106
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
12/24/2019
Last updated
11/10/2023
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