Wahconah Dialysis LLC

Primary specialty

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

Legal business name

WAHCONAH DIALYSIS LLC

Practice address

601 Washington Ave
Ste F
Manahawkin, NJ 08050-2861

Phone

(609) 891-3070

Fax

(609) 891-3095

NPI assigned

Dec 9, 2020

Organization subpart

No

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

Authorized official

Name

Samuel Wey

Title

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Manahawkin Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Listed as

DaVita ManahawkinCCN 312713

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Aug 5, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

10

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Davita Inc

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Dva Healthcare Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pearsall, TX
  • NPI 1194789859

  Member Of

  NPD member
• Isd Renal Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Canton, OH
  • NPI 1629596267

  Member Of

  NPD member
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Locations

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Jatinder Kohli, M.B.B.S.

  • Nephrology Physician
  • Philadelphia, PA
  • NPI 1518224567

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771372800000",
    "number": "1164028627",
    "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": "601 WASHINGTON AVE",
            "address_2": "STE F",
            "city": "MANAHAWKIN",
            "state": "NJ",
            "postal_code": "080502861",
            "telephone_number": "609-891-3070",
            "fax_number": "609-891-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAHCONAH DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-09",
        "last_updated": "2026-02-18",
        "certification_date": "2026-02-18",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP, LICENSURE & CERTIFICATION",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0889938",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manahawkin Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa Simone Vernon, M.D.
• Cynthia Israel Victor-Prophete, DO
• Chellappan Vijayakumar, M.D.
• Jomari Villanueva
• Susan Vogel
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Walgreen Co
• Sierra Janel Walker

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Manahawkin, NJ
• Providers in Manahawkin, NJ by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.