Provider Demographics
NPI:1487703526
Name:KNEIDL, CATHLEEN MARY (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:MARY
Last Name:KNEIDL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19 BOWLING LN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6707
Mailing Address - Country:US
Mailing Address - Phone:631-243-3373
Mailing Address - Fax:
Practice Address - Street 1:2975 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2518
Practice Address - Country:US
Practice Address - Phone:914-328-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005002-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical