Healthcare Provider Details

I. General information

NPI: 1932320116
Provider Name (Legal Business Name): JEROME FRANCIS KNAST PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 HEATHER RD SUITE 100
BALA CYNWYD PA
19004-3009
US

IV. Provider business mailing address

2227 WALLACE ST
PHILADELPHIA PA
19130-3125
US

V. Phone/Fax

Practice location:
  • Phone: 215-601-1413
  • Fax:
Mailing address:
  • Phone: 215-232-1417
  • Fax: 856-384-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS003306L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: