Provider Demographics
NPI:1093907420
Name:KNIGHT, GARY DESMOND (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DESMOND
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2038
Mailing Address - Country:US
Mailing Address - Phone:856-910-0495
Mailing Address - Fax:856-910-0193
Practice Address - Street 1:107 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2038
Practice Address - Country:US
Practice Address - Phone:856-910-0495
Practice Address - Fax:856-910-0193
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00469900111NR0400X
NJ40QA001496002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU60465Medicare UPIN
NJ449998Medicare PIN