Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
Richmond Kidney Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (ASSISTANT SECRETARY)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1366 VICTORY BLVD, STATEN ISLAND, NY 10301-3907
(718) 816-6200
(718) 816-6235
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
—
03009152
—
NY
Enumeration date
06/15/2006
Last updated
02/18/2026
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