Healthcare Provider Details

I. General information

NPI: 1821730854
Provider Name (Legal Business Name): CHRISTIAN KNOBLOCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

321 E 79TH ST APT 2A
NEW YORK NY
10075-0908
US

V. Phone/Fax

Practice location:
  • Phone: 706-802-3025
  • Fax:
Mailing address:
  • Phone: 253-217-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number99841
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number99841
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number99841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: