Healthcare Provider Details

I. General information

NPI: 1093058240
Provider Name (Legal Business Name): MICHAEL LEE KNUDSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PONDFIELD RD STE 1
BRONXVILLE NY
10708-3706
US

IV. Provider business mailing address

622 W 168TH ST PH 111130
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5976
  • Fax: 212-305-6193
Mailing address:
  • Phone: 212-305-5974
  • Fax: 212-305-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number292550
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: