Healthcare Provider Details

I. General information

NPI: 1306934161
Provider Name (Legal Business Name): ISLAND REPRODUCTIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 FIREMANS MEMORIAL DR
POMONA NY
10970-3553
US

IV. Provider business mailing address

1110 SOUTH AVE
STATEN ISLAND NY
10314-3403
US

V. Phone/Fax

Practice location:
  • Phone: 845-362-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC KNOCHENHAUER
Title or Position: OWNER
Credential: MD
Phone: 845-362-8400