Provider Demographics
NPI:1164419529
Name:KNOTT, ANTHONY FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FREDERICK
Last Name:KNOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 JOHN DRIVE
Mailing Address - Street 2:UPSTAIRS
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1958
Mailing Address - Country:US
Mailing Address - Phone:631-320-0859
Mailing Address - Fax:
Practice Address - Street 1:73 JOHN DRIVE
Practice Address - Street 2:UPSTAIRS
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1958
Practice Address - Country:US
Practice Address - Phone:631-320-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH41130Medicare UPIN
NY1247P1Medicare PIN