Provider Demographics
NPI:1851575708
Name:KNORR, GREGORY STARR (RPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:STARR
Last Name:KNORR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32-3 TAMERON DR
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1081 PAULISON AVE
Practice Address - Street 2:1
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3658
Practice Address - Country:US
Practice Address - Phone:973-253-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00685700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042589Medicare UPIN