Healthcare Provider Details

I. General information

NPI: 1043248776
Provider Name (Legal Business Name): KNAPP STREET PSYCHIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/13/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 KNAPP ST STE 306
BROOKLYN NY
11235-1005
US

IV. Provider business mailing address

PO BOX 68048
NEWARK NJ
07101-8085
US

V. Phone/Fax

Practice location:
  • Phone: 888-515-3834
  • Fax: 855-688-6746
Mailing address:
  • Phone: 888-515-3834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number013758
License Number StateNY

VIII. Authorized Official

Name: LARRY DURLOFSKY
Title or Position: OWNER
Credential: DO
Phone: 888-515-3834