Provider Demographics
NPI:1295749430
Name:KNOCHENHAUER, ERIC S (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:KNOCHENHAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 RICHMOND VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2622
Mailing Address - Country:US
Mailing Address - Phone:718-948-6100
Mailing Address - Fax:718-948-6114
Practice Address - Street 1:237 RICHMOND VALLEY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2622
Practice Address - Country:US
Practice Address - Phone:718-948-6100
Practice Address - Fax:718-948-6114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187839207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02139540Medicaid
NY450E81Medicare ID - Type Unspecified
NY02139540Medicaid