Provider Demographics
NPI:1558648113
Name:KNITTEL, WALTER EMIL
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:EMIL
Last Name:KNITTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 JACKSON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07863-3318
Mailing Address - Country:US
Mailing Address - Phone:908-689-7571
Mailing Address - Fax:
Practice Address - Street 1:96 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1836
Practice Address - Country:US
Practice Address - Phone:908-454-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R101271300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist