Provider Demographics
NPI:1790742260
Name:KNEE CENTER OF WNY
Entity Type:Organization
Organization Name:KNEE CENTER OF WNY
Other - Org Name:KEITH C STUBE MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:STUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-839-5858
Mailing Address - Street 1:180 PARK CLUB LN
Mailing Address - Street 2:SUITE 225
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5263
Mailing Address - Country:US
Mailing Address - Phone:716-839-5858
Mailing Address - Fax:716-839-5925
Practice Address - Street 1:180 PARK CLUB LN
Practice Address - Street 2:SUITE 225
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5263
Practice Address - Country:US
Practice Address - Phone:716-839-5858
Practice Address - Fax:716-839-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1193540002Medicare NSC