National Provider Identifier
Knickerbocker Dialysis Inc
Knickerbocker Dialysis Inc is listed in the NPPES registry with a primary specialty of End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Rochester, NY and a listed phone number of (585) 266-7348.
Profile Overview
- NPI
- 1942745666
- Provider Type
- Organization
- Primary Specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Enumeration Date
- January 04, 2017
- Last Updated
- May 01, 2024
Practice Location
- 999 E Ridge RD
- Ste 11
- Rochester, NY 14621-1936
Phone: (585) 266-7348
Mailing Address
- 5200 Virginia Way
- L & C Dept
- Brentwood, TN 37027-7569
Specialties
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X)
Full Record
- NPI
- 1942745666
- Entity Type
- Organization
- EIN
- <UNAVAIL>
- Organization Name
- Knickerbocker Dialysis Inc
- Other Organization Name
- <Unavail>
- Provider Other Organization Name Type Code
- 6
- Mailing Street Address
- 5200 Virginia Way
- Mailing Address Line 2
- L & C Dept
- Mailing City
- Brentwood
- Mailing State
- TN
- Mailing ZIP Code
- 37027-7569
- Mailing Country
- US
- Practice Street Address
- 999 E Ridge RD
- Practice Address Line 2
- Ste 11
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14621-1936
- Practice Country
- US
- Practice Phone
- (585) 266-7348
- Practice Fax
- (585) 266-4685
- Enumeration Date
- January 04, 2017
- Last Updated
- May 01, 2024
- Authorized Official Last Name
- Wey
- Authorized Official First Name
- Samuel
- Authorized Official Title
- Vp, Licensure & Certification
- Authorized Official Phone
- (615) 341-6641
- Organization Subpart
- No
- Certification Date
- May 01, 2024
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X)
- Other Identifiers
- 04935008 (NY)