KNICKERBOCKER DIALYSIS INC NPI 1679517270

NPI Information

NPI: 1679517270
Provider Name: KNICKERBOCKER DIALYSIS INC

Doing Business As: RICHMOND KIDNEY CENTER

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
1366 VICTORY BLVD
STATEN ISLAND, NY
ZIP 10301
Phone: (718) 816-6200
Get Directions

KNICKERBOCKER DIALYSIS INC is an end-stage renal disease (esrd) treatment clinic center in Staten Island, NY. KNICKERBOCKER DIALYSIS INC NPI is 1679517270. The provider is registered as an organization entity type.
The provider Is Doing Business As Richmond Kidney Center.

The provider's business location address is:

1366 VICTORY BLVD
STATEN ISLAND, NY
ZIP 10301-907
Phone: (718) 816-6200
Fax: (718) 816-6235

The provider's authorized official is Samuel Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 33D0653466 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/15/2006 and was last updated on 1/10/2024.

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	03009152	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: 4/28/2024

NPI Synchronization or Removal

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