Individual provider Active NPI

Kirk Knutsen, M.S.

  • Audiologist
  • Lyndhurst, NJ
National Provider Identifier
1104944594
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
41YA00002900 Issued in NJ
Practice address
644 Rutherford Ave
Lyndhurst, NJ 07071-1217
Phone
(201) 939-5141
NPI assigned
Mar 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 41YA00002900 NJ Primary

Addresses

Primary practice location

644 Rutherford Ave
Lyndhurst, NJ 07071-1217

Mailing address

644 Rutherford Ave
Lyndhurst, NJ 07071-1217
Phone (201) 939-5141

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071019000267 NJ Practitioner - Qualified Audiologist 5092800169 Practice locations: Lyndhurst, NJ

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

143 Ridge Rd
Lyndhurst, NJ 07071-1235
Phone (201) 819-3707

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Master of Science

State licenses

LicenseStateTypeSpecialty
41YA00002900NJMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lyndhurst Audiology Associates. LLC PastSince Jan 1, 1990 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104944594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 RUTHERFORD AVE",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070711217",
            "telephone_number": "201-939-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 RUTHERFORD AVE",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070711217",
            "telephone_number": "201-939-5141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNUTSEN",
        "first_name": "KIRK",
        "name_prefix": "Mr.",
        "credential": "M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NJ",
            "license": "41YA00002900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyndhurst, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.