Healthcare Provider Details

I. General information

NPI: 1982600433
Provider Name (Legal Business Name): GEORGE KNEISSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 HWY 35
RED BANK NJ
07701-5047
US

IV. Provider business mailing address

565 HWY 35
RED BANK NJ
07701-5047
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-4443
  • Fax: 732-747-4439
Mailing address:
  • Phone: 732-747-4443
  • Fax: 732-747-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA 06377100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: