Healthcare Provider Details

I. General information

NPI: 1295749430
Provider Name (Legal Business Name): ERIC S KNOCHENHAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 RICHMOND VALLEY RD
STATEN ISLAND NY
10309-2622
US

IV. Provider business mailing address

237 RICHMOND VALLEY RD
STATEN ISLAND NY
10309-2622
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-6100
  • Fax: 718-948-6114
Mailing address:
  • Phone: 718-948-6100
  • Fax: 718-948-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number187839
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: