=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841866464
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURIE KNAPP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2021
-----------------------------------------------------
Last Update Date | 06/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11835 RT 9W
-----------------------------------------------------
City | WEST COXSACKIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12192-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-264-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2810 W OLD STATE RD
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12303-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-526-0206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------