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GRAND BOULEVARD DIALYSIS
NPI 1386205714
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Deer Park, NY

Active since June 26, 2019CLIA 33D2171632 · Waiver
3/5
Overall Rating
860 GRAND BLVD, DEER PARK, NY 11729(631) 243-7770(631) 243-7775 Get Directions Write a Review

NPPES record last updated: July 14, 2021. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Grand Boulevard Dialysis NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAND BOULEVARD DIALYSIS (NPI 1386205714) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Deer Park, New York and active in the NPI registry since June 2019. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists John D Winstel, Chief Accounting Officer, as its authorized official.

NPPES Registry Identity

NPI1386205714
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameKNICKERBOCKER DIALYSIS INC
Location Address860 GRAND BLVDDeer Park, NY 11729-5706
Mailing Address5200 Virginia Way, L&c DeptBrentwood, TN 37027-7569 · (615) 341-6410 · Fax (888) 662-8259
Phone(631) 243-7770
Fax(631) 243-7775
Organization SubpartNo
Authorized OfficialJohn D WinstelChief Accounting Officer · (253) 733-4501
Enumeration DateJune 26, 2019
Last NPPES UpdateJuly 14, 2021
NPPES CertifiedJuly 14, 2021
✔ NPI 1386205714 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
860 GRAND BLVD, Deer Park, NY 11729
Open in Google Maps ↗

Other Names 1

Doing Business AsGrand Boulevard Dialysis

Other Identifiers 1

Medicaid06222173NY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Oscar Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2171632

Grand Boulevard Dialysis · Deer Park, NY
Active · expires Mar 26, 2027
CLIA Number33D2171632
Laboratory TypeEnd Stage Renal Disease Dialysis Facility
Certificate Effective DateSeptember 5, 2019
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Sushil Sagar
Laboratory Phone(631) 243-7770
Laboratory LocationGrand Boulevard Dialysis860 Grand Blvd, Deer Park, NY 11729
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Dialysis Facility Quality Ratings CMS Care Compare

Quality ratings, services and patient survey results for DaVita Grand Boulevard Dialysis (CMS certification number 332808), from CMS Care Compare.

DaVita Grand Boulevard Dialysis

Dialysis facility · Deer Park, NY
3/5 CMS RatingRating period January 2020 to December 2023
OwnershipProfit
ChainDaVita
CMS Certification Number332808
ESRD NetworkNetwork 2
Hemodialysis Stations20
Medicare-Certified SinceFebruary 28, 2020
Location860 Grand BoulevardDeer Park, NY 11729 · Suffolk County
Phone(631) 243-7770
Services Offered
In-center hemodialysis

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TRUE NORTH III DC LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
860 GRAND BLVD
DEER PARK, NY 11729
Suffolk County (631) 243-7770

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Knickerbocker Dialysis Inc's NPI number?

The NPI number for Knickerbocker Dialysis Inc is 1386205714. It was assigned to this organization in the NPPES registry on June 26, 2019. The provider is doing business as Grand Boulevard Dialysis.

Where is Knickerbocker Dialysis Inc located?

Knickerbocker Dialysis Inc is located at 860 Grand Blvd, Deer Park, NY 11729. The listed phone number is (631) 243-7770.

What is Knickerbocker Dialysis Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Does Knickerbocker Dialysis Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2171632) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Knickerbocker Dialysis Inc a Medicare-certified dialysis facility?

Yes. DaVita Grand Boulevard Dialysis is a Medicare-certified dialysis facility, certified since February 28, 2020.

What quality rating does Knickerbocker Dialysis Inc have?

CMS rates DaVita Grand Boulevard Dialysis 3 out of 5 stars on Care Compare. The full measure detail is in the Dialysis Facility Quality section above.

What insurance does Knickerbocker Dialysis Inc accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Oscar Health, Oscar Health Insurance and Oscar Health Maintenance Organization of Florida and 5 other insurers list Knickerbocker Dialysis Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Knickerbocker Dialysis Inc was last updated on July 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.