MEDICARE: GEORGE KNEISSER

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1487749875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE KNEISSER

Provider Business Mailing Address
First Line	:	565 STATE ROUTE 35
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-5047
Country	:	US
Telephone Number	:	732-747-4443
Fax Number	:	732-747-4439

Provider Business Practice Location Address
First Line	:	565 STATE ROUTE 35
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-5047
Country	:	US
Telephone Number	:	732-747-4443
Fax Number	:	732-747-4439

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEORGE KNEISSER
Credential	:	MD
Telephone Number	:	732-747-4443

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/22/2008

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