KNICKERBOCKER DIALYSIS INC (NPI# 1386205714) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1386205714 |
Entity Type | Organization |
Organization Name | KNICKERBOCKER DIALYSIS INC |
Practice Address |
860 Grand Blvd Deer Park NY 11729-5706 |
Mailing Address |
5200 Virginia Way L and C Dept Brentwood TN 37027-7569 |
Practice Telephone | 6312437770 |
Practice Fax Number | 6312437775 |
Mailing Telephone | 6153204414 |
Mailing Fax Number | 8668652884 |
Enumeration Date | 2019-06-26 |
Last Update Date | 2019-06-26 |
Authorized Official Name | JAMES HILGER (CHIEF ACCOUNTING OFFICER) |
Authorized Official Telephone | 6153204414 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Grand Boulevard Dialysis | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043839269 | Knickerbocker Dialysis Inc | Clinic/Center | 5518 Avenue N, Brooklyn, NY 11234-4006 | 2020-04-09 |
1679192876 | Knickerbocker Dialysis Inc | Clinic/Center | 1734 Hancock St, Ridgewood, NJ 11385-4734 | 2020-04-09 |
1942839378 | Knickerbocker Dialysis Inc | Clinic/Center | 479 E Main St, Patchogue, NY 11772-3147 | 2020-04-07 |
1205461639 | Knickerbocker Dialysis Inc | Clinic/Center | 1277 Middle Country Rd, Middle Island, NY 11953 | 2020-03-05 |
1629617576 | Knickerbocker Dialysis Inc | Clinic/Center | 1633 Route 202 Ste 120, Pomona, NY 10970-2926 | 2019-12-24 |
1740824184 | Knickerbocker Dialysis Inc | Clinic/Center | 11 Romaine Ave, Yonkers, NY 10705 | 2019-10-29 |
1902456742 | Knickerbocker Dialysis Inc | Clinic/Center | 34 Marconi St Ste 110, Bronx, NY 10461-2755 | 2019-09-13 |
1407415243 | Knickerbocker Dialysis Inc | Clinic/Center | 931 Bruckner Blvd, Bronx, NY 10459-4525 | 2019-06-06 |
1306404926 | Knickerbocker Dialysis Inc | Clinic/Center | 203 W Route 59, Nanuet, NY 10954-2218 | 2019-05-29 |
1487133633 | Knickerbocker Dialysis Inc | Clinic/Center | 54 New Lots Ave, Brooklyn, NY 11212-6934 | 2018-08-08 |
Street Address |
860 GRAND BLVD |
City | DEER PARK |
State | NY |
Zip Code | 11729-5706 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013561513 | Elyse Joy Wright | Specialist | 1014 Grand Boulevard Suite 5, Deer Park, NY 11729 | 2019-08-01 |
1568929131 | Corrine E. Hibbert | Case Manager/Care Coordinator | 140 Villa Avenue, Deer Park Ny, NY 11729 | 2019-03-01 |
1922525286 | Melissa Ramistella | Behavioral Analyst | 6 Angelica Street, Deer Park, NY 11729 | 2017-08-28 |
1609224153 | Corvitals, Inc. | Clinical Medical Laboratory | 590 Nichols Road, Suite 1, Deer Park, NY 11729 | 2016-05-25 |
1417375312 | Venel Maitre | Registered Nurse | 54 Duke St, Deer Park, NY 11729 | 2014-03-29 |
1578819157 | Koa K Robinson | Registered Nurse | 375 Carlls Place, 329, Deer Park, NY 11729 | 2012-08-01 |
1649532409 | Theresa L Lerro | Counselor | 1 Brandyine Drive, Deer Park, NY 11729 | 2012-06-07 |
1417218827 | Abilities Unlimited of N.y. | Durable Medical Equipment & Medical Supplies | 90 E. Jefryn Blvd., Deer Park, NY 11729 | 2012-06-01 |
1356600811 | Jennifer A. D'auria | Speech-Language Pathologist | 101 Lake Ave., Jfk Intermediate School, Deer Park, NY 11729 | 2012-05-03 |
1013280254 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 1900 The Arches Circle, Deer Park, NY 11729 | 2012-02-20 |
Find all providers in zip 11729 |
Taxonomy Code | 261QE0700X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | End-Stage Renal Disease (ESRD) Treatment |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841574746 | Inland Northwest Renal Care Group LLC | Clinic/Center | 822 S. Main Street, Deer Park, WA 99006-8242 | 2011-10-11 |
1144332032 | Bio-medical Applications of Texas, Inc. | Clinic/Center | 4625 Center St, Deer Park, TX 77536-6352 | 2006-08-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194323071 | True North Dialysis Center LLC | Clinic/Center | 668 Middle Country Rd, Selden, NY 11784-2521 | 2020-10-13 |
1952908386 | Ulster Dialysis, LLC | Clinic/Center | 900 Miron Ln, Kingston, NY 12401-1567 | 2020-10-08 |
1376152868 | True North Dialysis Center LLC | Clinic/Center | 3005 Long Beach Rd, Oceanside, NY 11572 | 2020-07-30 |
1043839269 | Knickerbocker Dialysis Inc | Clinic/Center | 5518 Avenue N, Brooklyn, NY 11234-4006 | 2020-04-09 |
1942839378 | Knickerbocker Dialysis Inc | Clinic/Center | 479 E Main St, Patchogue, NY 11772-3147 | 2020-04-07 |
1225667819 | New York Dialysis Services, Inc | Clinic/Center | 1 East Jericho Turnpike, Mineola, NY 11501 | 2020-04-06 |
1205461639 | Knickerbocker Dialysis Inc | Clinic/Center | 1277 Middle Country Rd, Middle Island, NY 11953 | 2020-03-05 |
1326678111 | New York Dialysis Services, Inc | Clinic/Center | 794 St Anns Ave, Bronx, NY 10456 | 2020-01-21 |
1629617576 | Knickerbocker Dialysis Inc | Clinic/Center | 1633 Route 202 Ste 120, Pomona, NY 10970-2926 | 2019-12-24 |
1740824184 | Knickerbocker Dialysis Inc | Clinic/Center | 11 Romaine Ave, Yonkers, NY 10705 | 2019-10-29 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.