Provider Demographics
NPI:1255357588
Name:KNAUB, JENNY (ANP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:KNAUB
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2583
Mailing Address - Country:US
Mailing Address - Phone:631-727-2100
Mailing Address - Fax:631-727-2646
Practice Address - Street 1:1279 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2583
Practice Address - Country:US
Practice Address - Phone:631-727-2100
Practice Address - Fax:631-727-2646
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301562363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03178883Medicaid
NY03178883Medicaid
NYA100001194Medicare PIN