Knickerbocker Dialysis Inc
NPI 1508366386 · End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Mount Vernon, NY
Enrolled with Medicare as Part a Provider - End-Stage Renal Disease Facility (esrd) · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1508366386
- Entity type
- Organization
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Samuel Wey, Assistant Secretary(615) 341-6641
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Sandford Boulevard Dialysis
Registry dates
- Enumerated
- 2018-02-18
- Last updated
- 2026-05-29
- Certified
- 2026-05-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.