Healthcare Provider Details

I. General information

NPI: 1366407264
Provider Name (Legal Business Name): DAVID J KNEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EMERSON LN STE 1503
BRIDGEVILLE PA
15017-3484
US

IV. Provider business mailing address

100 EMERSON LN STE 1503
BRIDGEVILLE PA
15017-3484
US

V. Phone/Fax

Practice location:
  • Phone: 412-977-2051
  • Fax:
Mailing address:
  • Phone: 412-977-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS009476L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberOS009476L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: