Provider Demographics
NPI:1811031081
Name:KNOBLER INSTITUTE OF NEUROLOGIC DISEASE, PC
Entity Type:Organization
Organization Name:KNOBLER INSTITUTE OF NEUROLOGIC DISEASE, PC
Other - Org Name:KIND CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:KNOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:215-643-9045
Mailing Address - Street 1:520 PINETOWN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2611
Mailing Address - Country:US
Mailing Address - Phone:215-643-9045
Mailing Address - Fax:215-643-9049
Practice Address - Street 1:520 PINETOWN RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2611
Practice Address - Country:US
Practice Address - Phone:215-643-9045
Practice Address - Fax:215-643-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031526E261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B35552Medicare UPIN