Healthcare Provider Details

I. General information

NPI: 1063612596
Provider Name (Legal Business Name): COLETTE MONIQUE KNIGHT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 OVERLOOK AVE
HACKENSACK NJ
07601-2206
US

IV. Provider business mailing address

150 OVERLOOK AVE
HACKENSACK NJ
07601-2206
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-5999
  • Fax: 201-489-1898
Mailing address:
  • Phone: 201-489-5999
  • Fax: 201-489-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number228132
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA08204800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: