Provider Demographics
NPI:1538371273
Name:KNOLL, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KNOLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330, 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072
Mailing Address - Country:US
Mailing Address - Phone:201-438-7598
Mailing Address - Fax:
Practice Address - Street 1:582 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1936
Practice Address - Country:US
Practice Address - Phone:973-674-3808
Practice Address - Fax:973-674-3943
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1807156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6012809Medicaid