Basic Information
| Provider Information | |||||||||
| NPI: | 1528357043 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNICKELBEIN | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | EVAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD/PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | MSC10 5610 | ||||||||
| Address2: | 1 UNIVERSITY OF NEW MEXICO | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052726120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 203 LOTHROP ST FL 8 | ||||||||
| Address2: | UPMC EYE CENTER | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126472256 | ||||||||
| FaxNumber: | 4126475119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2011 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MT197844 | PA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | RS2013-0363 | NM | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.