NPIMap

Organization Active NPI

Knickerbocker Dialysis Inc

Doing business as Stuyvesant Heights Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1578063327
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
KNICKERBOCKER DIALYSIS INC
Doing business as
Stuyvesant Heights Dialysis
Practice address
2064 Atlantic Ave
Brooklyn, NY 11233-3162
Phone
(718) 346-0475
Fax
(718) 346-4695
NPI assigned
Feb 19, 2018
Last updated
Jul 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

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

Addresses

Primary practice location

2064 Atlantic Ave
Brooklyn, NY 11233-3162

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
06576085MedicaidNY

Other names 1

  • Stuyvesant Heights Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180312001553 NY Part A Provider - End-Stage Renal Disease Facility (ESRD) 9436178191 Practice locations: Brooklyn, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578063327. Details of each certification follow.

  • CCN 332815 End-stage renal disease facility · Active · Name & address match · Details

End-stage renal disease facility certification: CCN 332815

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
STUYVESANT HEIGHTS DIALYSIS
Certification status
Active
Provider type (POS)
End-stage renal disease facility
Participating since
Oct 2, 2020
Last certification
Oct 2, 2020
Ownership / control type
For Profit
Multi-facility organization
DAVITA INC
Facility address
2064 Atlantic Avenue
Brooklyn, NY 11233

National Provider Directory

National Provider Directory
Tax ID family
Knickerbocker Dialysis Inc65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1578063327",
    "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": "2064 ATLANTIC AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112333162",
            "telephone_number": "718-346-0475",
            "fax_number": "718-346-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNICKERBOCKER DIALYSIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-19",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06576085",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stuyvesant Heights Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.