MEDICARE: SPINE CARE MEDICINE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1134929896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE CARE MEDICINE PC

Provider Business Mailing Address
First Line	:	48 FROST LN UNIT A
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1806
Country	:	US
Telephone Number	:	516-862-1202
Fax Number	:	516-758-1278

Provider Business Practice Location Address
First Line	:	48 FROST LN UNIT A
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1806
Country	:	US
Telephone Number	:	516-862-1202
Fax Number	:	516-758-1278

Authorized Official
Title or Position	:	OWNER
Name	:	ABRAHAM D KNOLL
Credential	:	MD
Telephone Number	:	551-206-1222

Provider Enumeration Date	:	03/13/2025
Last Update Date	:	03/13/2025

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Directions to “SPINE CARE MEDICINE PC ” Practice Location

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