Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
Queens Village Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (ASSISTANT SECRETARY)
(615) 341-6641
Entity
Organization
Contact information
Practice address
22202 HEMPSTEAD AVE, STE 170, QUEENS VILLAGE, NY 11429-2123
(718) 217-6200
(718) 217-4191
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
—
03055098
—
NY
Enumeration date
06/18/2006
Last updated
07/16/2025
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