Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
Queens Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (ASSISTANT SECRETARY)
(615) 341-6641
Entity
Organization
Contact information
Practice address
11801 GUY R BREWER BLVD, JAMAICA, NY 11434-2101
(718) 341-6711
(718) 525-8611
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
—
03047385
—
NY
Enumeration date
06/28/2006
Last updated
04/08/2025
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