Provider Demographics
NPI:1134929896
Name:SPINE CARE MEDICINE PC
Entity type:Organization
Organization Name:SPINE CARE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-206-1222
Mailing Address - Street 1:48 FROST LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1806
Mailing Address - Country:US
Mailing Address - Phone:516-862-1202
Mailing Address - Fax:516-758-1278
Practice Address - Street 1:48 FROST LN UNIT A
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1806
Practice Address - Country:US
Practice Address - Phone:516-862-1202
Practice Address - Fax:516-758-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty