Grand Boulevard Dialysis

LBN: Knickerbocker Dialysis Inc
Grand Boulevard Dialysis is an health care organization with primary practice located at 860 Grand Blvd , Deer Park NY 11729-5706. The organization recently has only one registered license in Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment, which is considered as the primary health care specialty. Knickerbocker Dialysis Inc can be contacted via phone (631) 243-7770, or through Winstel, John D via phone (253) 733-4501.

Contact Information

Primary practice address
860 Grand Blvd Deer Park NY 11729-5706
Phone: (631) 243-7770
Fax: (631) 243-7775
Website:
Map and Directions
Authorized official contact:
Name: Winstel, John D
Phone: (253) 733-4501

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment 261QE0700X

Profile Details

NPI number 1386205714
LBN Legal business name Knickerbocker Dialysis Inc
DBA Doing business as Grand Boulevard Dialysis
Authorized official Winstel, John D
Entity Organization
Organization subpart 1 No
Enumeration date Jun 26th, 2019
Last updated Jul 14th, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386205714 NPPES
New York MEDICAID 06222173

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