Provider Demographics
NPI:1184839581
Name:KNOBLOCK, PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:KNOBLOCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 GENESEE PARK DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1563
Mailing Address - Country:US
Mailing Address - Phone:315-446-8419
Mailing Address - Fax:
Practice Address - Street 1:2100 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2249
Practice Address - Country:US
Practice Address - Phone:315-425-9802
Practice Address - Fax:315-425-9836
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002949-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist