Organization Active NPI

Liberty RC Inc

Doing business as Dyker Heights Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1104155894
Registry record updated Apr 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
LIBERTY RC INC
Doing business as
Dyker Heights Dialysis Center
Practice address
1435 86TH St
Brooklyn, NY 11228-3435
Phone
(718) 256-5800
Fax
(718) 256-4835
NPI assigned
Dec 9, 2009
Last updated
Apr 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samuel Wey
Title
Assistant Secretary
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

1435 86TH St
Brooklyn, NY 11228-3435

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other names 1

  • Dyker Heights Dialysis Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100621000548 NY Part A Provider - End-Stage Renal Disease Facility (ESRD) 9436199304 Practice locations: Brooklyn, NY

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Liberty RC Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775779200000",
    "number": "1104155894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 86TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112283435",
            "telephone_number": "718-256-5800",
            "fax_number": "718-256-4835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY RC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-09",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dyker Heights Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dyker Heights Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.