Provider Demographics
NPI:1912057761
Name:ISLAND REPRODUCTIVE SERVICES, PC
Entity Type:Organization
Organization Name:ISLAND REPRODUCTIVE SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNOCHENHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-948-6100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187839207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02139540Medicaid
NY450E81Medicare ID - Type Unspecified
NY02139540Medicaid