Provider Demographics
NPI:1053816348
Name:KNOX, JUSTIN A
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:A
Last Name:KNOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 W 153RD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1114
Mailing Address - Country:US
Mailing Address - Phone:646-279-5693
Mailing Address - Fax:
Practice Address - Street 1:467 W 153RD ST APT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1114
Practice Address - Country:US
Practice Address - Phone:646-279-5693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY299235737OtherBLUE CROSS BLUE SHEILD