MEDICARE: KNAPP STREET PSYCHIATRY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	2084P0800X	Psychiatry Physician
3	363A00000X	Physician Assistant
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	103TC0700X	Clinical Psychologist	013758	NY

General Provider Information

NPI Number	:	1043248776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNAPP STREET PSYCHIATRY, PC

Provider Business Mailing Address
First Line	:	PO BOX 68048
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07101-8085
Country	:	US
Telephone Number	:	888-515-3834
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 KNAPP ST STE 306
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1005
Country	:	US
Telephone Number	:	888-515-3834
Fax Number	:	855-688-6746

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY DURLOFSKY
Credential	:	DO
Telephone Number	:	888-515-3834

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/13/2025

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