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General NPI Number Information
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NPI Number | 1871912790
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Entity Type | Individual
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Provider Name | JONATHAN KNEIB MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 100 NICOLLS RD RM 80
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City | STONY BROOK
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State | NY
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Zip | 11794-9350
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Country | US
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Telephone | 631-444-2478
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Fax |
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Provider Business Mailing Address
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Address Line | JONATHAN KNEIB P.O. BOX 1554
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City | STONY BROOK
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State | NY
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Zip | 11790
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 289098
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License Number State | NY
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