Provider Demographics
NPI:1316034796
Name:KNECHT, AMY (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KNECHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-2625
Mailing Address - Country:US
Mailing Address - Phone:856-904-4050
Mailing Address - Fax:
Practice Address - Street 1:806 W SHORE DR
Practice Address - Street 2:
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203-2625
Practice Address - Country:US
Practice Address - Phone:856-904-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00386900174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ159350XXOtherPREFERRED CARE
NJ5834637OtherCIGNA PPO
NJ2229169OtherFIRST HEALTH
NJ437095OtherHIGHMARK BLUE SHIELD
NJ437095Medicare ID - Type Unspecified