1609935444 NPI number — ADULT CARE PSYCHOLOGY SERVICES, PLLC

Table of content: DR. JONATHAN KNOWLTON MD, PHD (NPI 1881217438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609935444 NPI number — ADULT CARE PSYCHOLOGY SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADULT CARE PSYCHOLOGY SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609935444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13711 73RD TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11367-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-575-3510
Provider Business Mailing Address Fax Number:
718-575-0391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13711 73RD TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11367-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-575-3510
Provider Business Practice Location Address Fax Number:
718-575-0391
Provider Enumeration Date:
12/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUTNER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
718-575-3510

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02164212 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000409099 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 678886 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 403672 . This is a "EMBLEM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7379731 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 814181000 . This is a "MAGELLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com