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General NPI Number Information
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NPI Number | 1225245335
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Entity Type | Organization
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Legal Business Name | MONTAUK MEDICAL CARE PC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 699 MAIN STREET
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City | MONTAUK
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State | NY
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Zip | 11954-0123
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Country | US
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Telephone | 631-668-3705
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Fax | 631-668-1148
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Provider Business Mailing Address
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Address Line | PO BOX 123 699 MAIN STREET
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City | MONTAUK
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State | NY
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Zip | 11954-0123
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Country | US
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Telephone | 631-668-3705
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Fax | 631-668-1148
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY KNOTT
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Credential | MD
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Telephone | 631-668-3705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 232102
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License Number State | NY
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