1225123961 NPI number — DR. C. MICHAEL KNEE M.D.

Table of content: DR. C. MICHAEL KNEE M.D. (NPI 1225123961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225123961 NPI number — DR. C. MICHAEL KNEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNEE
Provider First Name:
C.
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNEE
Provider Other First Name:
C.
Provider Other Middle Name:
MICHAEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225123961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 GODWIN AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MIDLAND PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07432-1969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-444-5004
Provider Business Mailing Address Fax Number:
201-670-0356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 GODWIN AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MIDLAND PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07432-1969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-444-5004
Provider Business Practice Location Address Fax Number:
201-670-0356
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA03716000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3058905 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1028498 . This is a "HORIZON MERCY OFFICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 222379156 . This is a "TAX I.D." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 90000053401 . This is a "AMERICHOICE OFFICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01077794100 . This is a "AMERICHOICE ST. JOSEPH'S" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 370017079 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 49705 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 10764 . This is a "AMERIGROUP-AMERICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P1225478 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: HNF11542 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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