Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Knickerbocker Dialysis Inc

Organization End-Stage Renal Disease (ESRD) Treatment Clinic/Center · NPI 1386205714

Knickerbocker Dialysis Inc is an End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Deer Park, New York. Medicare rates this dialysis facility 4 out of 5. Registered with an NPI since 2019.

CMS rating
4 of 5
In the registry since
2019
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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CMS quality rating

4 out of 5 — official dialysis facility rating from CMS Care Compare (CCN 332808)

Practice location Address checks out

860 Grand Blvd
Deer Park, NY 11729-5706
Phone: (631) 243-7770
Fax: (631) 243-7775
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

End-Stage Renal Disease (ESRD) Treatment Clinic/Center (primary) Taxonomy 261QE0700X

Record details

NPI number1386205714
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Winstel — Chief Accounting Officer · (253) 733-4501
Other names Grand Boulevard Dialysis; Grand Boulevard Dialysis
NPI enumeratedJune 26, 2019
Last updated in NPPESJuly 14, 2021
Certification dateJuly 14, 2021
Mailing address5200 Virginia Way, L&C Dept, Brentwood, TN 37027-7569

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