Basic Information
| Provider Information | |||||||||
| NPI: | 1003826025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNUDSEN | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 427 GUY PARK AVE | ||||||||
| Address2: | ST MARYS HOSPITAL | ||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188421900 | ||||||||
| FaxNumber: | 5188417131 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 GUY PARK AVE | ||||||||
| Address2: | ST MARYS HOSPITAL | ||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188421900 | ||||||||
| FaxNumber: | 5188417131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 08/29/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 146433-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 146433 | 05 | NY | MEDICAID |