Kittery Dialysis LLC

Primary specialty

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

Legal business name

KITTERY DIALYSIS LLC

Doing business as

West Paterson Dialysis

Practice address

490 Chamberlain Ave
Paterson, NJ 07522-1089

Phone

(862) 657-5572

Fax

(862) 657-5644

NPI assigned

Jan 18, 2022

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 names 1

• West Paterson Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Listed as

DaVita West PatersonCCN 312715

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Feb 13, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

19

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

CLIA laboratory certificates

Member of 3

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

• St Joseph'S Hospital and Medical Center

  • Rehabilitation Hospital Unit
  • Wayne, NJ
  • NPI 1609847870

  Member Of

  NPD member
• 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

Locations

Affiliated clinicians 3

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

• Nazifa Banu, MD

  • Nephrology Physician
  • Wayne, NJ
  • NPI 1861562662

  Dialysis facility

  Care Compare affiliation Name & address match
• Meghna Desai

  • Nephrology Physician
  • Wayne, NJ
  • NPI 1629384821

  Dialysis facility

  Care Compare affiliation Name & address match
• Harjinder Singh Saini, MD

  • Nephrology Physician
  • Wayne, NJ
  • NPI 1134147531

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1720739055",
    "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": "490 CHAMBERLAIN AVE",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075221089",
            "telephone_number": "862-657-5572",
            "fax_number": "862-657-5644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITTERY DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-18",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Paterson Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Paterson Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vivian Jiyoung Kim, D.D.S.
• Jeffrey James Kinyon, D.O.
• Trixie Kioko-Kamps, CNM
• Charlotte Kirk, DO
• Jaclyn Kirshbaum
• Serdal Brian Kocak, DDS
• Jalal Koj, MD
• Monika Komosinski, CRNA
• Mary T Kondoleon, MD
• Mersiha Konjhodzic

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Paterson, NJ
• Providers in Paterson, 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 Apr 8, 2025; 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.