Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 38MC00469900 | NJ |
N | 2251X0800X | Physical Therapist - Orthopedic | 40QA00149600 | NJ |
NPI | 1093907420 |
---|---|
Provider Name | Dr. Gary Desmond Knight |
First Address | Merchantville, NJ 08109-2038 |
Second Address | Merchantville, NJ 08109-2038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 09/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U60465 | (02) | NJ |