Knickerbocker Family Dental Center PC

Primary specialty

DentistTaxonomy code 122300000X

License

039714 Issued in NY

Legal business name

KNICKERBOCKER FAMILY DENTAL CENTER PC

Practice address

214 Stanhope St
Brooklyn, NY 11237-4202

Phone

(718) 574-0527

Fax

(718) 715-0624

NPI assigned

Mar 4, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Larry D Jacobs

Title

Chief Operating Officer

Phone

(718) 574-0527

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1172966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861521262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 STANHOPE ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374202",
            "telephone_number": "718-574-0527",
            "fax_number": "718-715-0624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 STANHOPE ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374202",
            "telephone_number": "718-574-0527",
            "fax_number": "718-715-0624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNICKERBOCKER FAMILY DENTAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "718-574-0527",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "039714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS DENTAL LICENSE",
            "identifier": "037914",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Yocheved Knieberg
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• Adriene Knight
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• Dentist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.