Provider Demographics
NPI:1225123961
Name:KNEE, C. MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:C.
Middle Name:MICHAEL
Last Name:KNEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:MICHAEL
Other - Last Name:KNEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:44 GODWIN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1969
Mailing Address - Country:US
Mailing Address - Phone:201-444-5004
Mailing Address - Fax:201-670-0356
Practice Address - Street 1:44 GODWIN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1969
Practice Address - Country:US
Practice Address - Phone:201-444-5004
Practice Address - Fax:201-670-0356
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03716000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3058905Medicaid
NJ1028498OtherHORIZON MERCY OFFICE
NJ222379156OtherTAX I.D.
NJ90000053401OtherAMERICHOICE OFFICE
NJ01077794100OtherAMERICHOICE ST. JOSEPH'S
NJ370017079OtherMEDICARE RAILROAD
NJ49705OtherAETNA
NJ10764OtherAMERIGROUP-AMERICAID
NJP1225478OtherOXFORD
NJHNF11542OtherHEALTH NET
NJ90000053401OtherAMERICHOICE OFFICE
NJ49705OtherAETNA