Knickerbocker Dialysis Inc

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

KNICKERBOCKER DIALYSIS INC

Practice address

21910 S Conduit Ave
Springfield Gardens, NY 11413-3462

Phone

(718) 341-0107

Fax

(718) 341-2255

NPI assigned

Apr 9, 2020

Organization subpart

Yes

Parent organization

DAVITA INCAs reported in NPPES

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

Authorized official

Name

John D Winstel

Title

Chief Accounting Officer

Phone

(615) 320-4414

Specialties & licenses 1

Addresses

Other names 1

• Conduit Avenue Dialysis Doing business as

Part of

Davita Inc

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

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586390400000",
    "number": "1114546256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L AND C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4414",
            "fax_number": "866-865-2884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21910 S CONDUIT AVE",
            "city": "SPRINGFIELD GARDENS",
            "state": "NY",
            "postal_code": "114133462",
            "telephone_number": "718-341-0107",
            "fax_number": "718-341-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNICKERBOCKER DIALYSIS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAVITA INC",
        "enumeration_date": "2020-04-09",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "615-320-4414"
    },
    "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": "Conduit Avenue Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Admira Keen
• Dionne Kelly
• Keshia Laporte Family Health Nurse Practitioner,PLLC
• Shaheed Khan, MD
• Zaid Ashraf Khan, RPH
• Nerlande Lafond
• Sandrale M Lahens
• Keshia Daniel Laporte, FNP
• Yvette Larose, LPN
• Ruben Lasalle

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Springfield Gardens, NY
• Providers in Springfield Gardens, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.