Provider Demographics
NPI:1083947089
Name:JONATHAN M. KNEE, DPM
Entity Type:Organization
Organization Name:JONATHAN M. KNEE, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-667-2225
Mailing Address - Street 1:514 GRAMATAN AVE
Mailing Address - Street 2:P4
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3054
Mailing Address - Country:US
Mailing Address - Phone:914-667-2225
Mailing Address - Fax:914-667-2224
Practice Address - Street 1:514 GRAMATAN AVE
Practice Address - Street 2:P4
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3054
Practice Address - Country:US
Practice Address - Phone:914-667-2225
Practice Address - Fax:914-667-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5335-1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01023642Medicaid
NYU71322Medicare UPIN