Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
Peconic Bay Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
700 OLD COUNTRY RD, STE 4, RIVERHEAD, NY 11901-2129
(631) 208-0282
(631) 208-0129
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
Enumeration date
05/26/2021
Last updated
12/29/2023
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