Basic Information
| Provider Information | |||||||||
| NPI: | 1518564996 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADA KNECHT DOM, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14075 SW 72ND CT | ||||||||
| Address2: | |||||||||
| City: | PALMETTO BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331581263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053420076 | ||||||||
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| Practice Location | |||||||||
| Address1: | 195 GIRALDA AVE | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331345208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055671973 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2020 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | KNECHT | ||||||||
| AuthorizedOfficialFirstName: | ADA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3053420076 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DOM | ||||||||
| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.