Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
South Bronx Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (ASSISTANT SECRETARY)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1940 WEBSTER AVE, STE 100, BRONX, NY 10457-4261
(718) 299-9212
(718) 583-7335
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
—
03048597
—
NY
Enumeration date
06/24/2006
Last updated
02/18/2025
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