Healthcare Provider Details

I. General information

NPI: 1134929896
Provider Name (Legal Business Name): SPINE CARE MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 FROST LN UNIT A
LAWRENCE NY
11559-1806
US

IV. Provider business mailing address

48 FROST LN UNIT A
LAWRENCE NY
11559-1806
US

V. Phone/Fax

Practice location:
  • Phone: 516-862-1202
  • Fax: 516-758-1278
Mailing address:
  • Phone: 516-862-1202
  • Fax: 516-758-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM D KNOLL
Title or Position: OWNER
Credential: MD
Phone: 551-206-1222