Provider Demographics
NPI:1750492773
Name:KNOBEL, JEFFREY MAYER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MAYER
Last Name:KNOBEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 E 14TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1100
Mailing Address - Country:US
Mailing Address - Phone:718-336-1800
Mailing Address - Fax:718-336-5968
Practice Address - Street 1:1636 E 14TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1100
Practice Address - Country:US
Practice Address - Phone:718-336-1800
Practice Address - Fax:718-336-5968
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004896213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01273789Medicaid
NYU29314Medicare UPIN
NYP2W142Medicare PIN
NY01273789Medicaid