Provider Demographics
NPI:1932123486
Name:KNOLL, CHARLES L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:KNOLL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:461 PARK AVE S
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-679-6464
Mailing Address - Fax:212-679-6872
Practice Address - Street 1:461 PARK AVE S
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-679-6464
Practice Address - Fax:212-679-6872
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY155939208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY95D531Medicare PIN
A6500Medicare UPIN