Healthcare Provider Details

I. General information

NPI: 1255121323
Provider Name (Legal Business Name): CONNOR JACOB KNIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST STE B280
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

100 HIGH ST STE B280
BUFFALO NY
14203-1126
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-3760
  • Fax: 716-859-4015
Mailing address:
  • Phone: 716-859-3760
  • Fax: 716-859-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: