KNICKERBOCKER DIALYSIS INC NPI 1871520361

NPI Information

NPI: 1871520361
Provider Name: KNICKERBOCKER DIALYSIS INC

Doing Business As: QUEENS DIALYSIS CENTER

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
11801 GUY R BREWER BLVD
JAMAICA, NY
ZIP 11434
Phone: (718) 341-6711
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KNICKERBOCKER DIALYSIS INC is an end-stage renal disease (esrd) treatment clinic center in Jamaica, NY. KNICKERBOCKER DIALYSIS INC NPI is 1871520361. The provider is registered as an organization entity type.
The provider Is Doing Business As Queens Dialysis Center.

The provider's business location address is:

11801 GUY R BREWER BLVD
JAMAICA, NY
ZIP 11434-101
Phone: (718) 341-6711
Fax: (718) 525-8611

The provider's authorized official is John D Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 33D0969991 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/28/2006 and was last updated on 4/20/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	03047385	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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