Provider Demographics
NPI:1427049535
Name:KNEE, JONATHAN M (DPM)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:KNEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 GRAMATAN AVE
Mailing Address - Street 2:P4
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3054
Mailing Address - Country:US
Mailing Address - Phone:914-667-2225
Mailing Address - Fax:914-667-2224
Practice Address - Street 1:514 GRAMATAN AVE
Practice Address - Street 2:P4
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3054
Practice Address - Country:US
Practice Address - Phone:914-667-2225
Practice Address - Fax:914-667-2224
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0053351213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01923642Medicaid
NY01923642Medicaid
U71322Medicare UPIN