Organization
KNICKERBOCKER DIALYSIS INC
Active
Other names
East Patchogue Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (ASSISTANT SECRETARY)
(615) 341-6641
Entity
Organization
Contact information
Practice address
479 E MAIN ST, PATCHOGUE, NY 11772-3147
(631) 447-2401
(631) 447-2406
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
—
06575855
—
NY
Enumeration date
04/07/2020
Last updated
04/21/2025
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