Provider Demographics
NPI:1609290824
Name:KNOX-MASK, AURA
Entity Type:Individual
Prefix:DR
First Name:AURA
Middle Name:
Last Name:KNOX-MASK
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:AURA
Other - Middle Name:
Other - Last Name:KNOX-MASK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18 BROADVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3612
Mailing Address - Country:US
Mailing Address - Phone:973-763-9212
Mailing Address - Fax:973-762-1084
Practice Address - Street 1:18 BROADVIEW AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3612
Practice Address - Country:US
Practice Address - Phone:973-763-9212
Practice Address - Fax:973-762-1084
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195162208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice