Provider Demographics
NPI:1548270150
Name:KNOWLES, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KNOWLES
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 1:500 ROUTE 23 N
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07444
Mailing Address - Country:US
Mailing Address - Phone:973-831-7660
Mailing Address - Fax:973-831-7644
Practice Address - Street 1:500 ROUTE 23 N
Practice Address - Street 2:SUITE 1A
Practice Address - City:PEQUANNOCK
Practice Address - State:NJ
Practice Address - Zip Code:07444
Practice Address - Country:US
Practice Address - Phone:973-831-7660
Practice Address - Fax:973-831-7644
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5434390001Medicare ID - Type Unspecified