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NPI Code Detail

MEDICARE: DR. PETER KNOBLOCK PH.D.

MEDICARE: DR. PETER KNOBLOCK PH.D.
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
1103T00000XPsychologist002949-1NY

General Provider Information

NPI Number : 1184839581
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER KNOBLOCK PH.D.
Provider Business Mailing Address
First Line : 331 GENESEE PARK DR
Second Line :
City : SYRACUSE
State : NY
Zip : 13224-1563
Country : US
Telephone Number : 315-446-8419
Fax Number :
Provider Business Practice Location Address
First Line : 2100 E GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-2249
Country : US
Telephone Number : 315-425-9802
Fax Number : 315-425-9836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2007
Last Update Date : 01/04/2026

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