Organization
RIDGEWOOD INFECTIOUS DISEASE ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY G KNACKMUHS M.D. (DELEGATED OFFICIAL)
(201) 447-6468
Entity
Organization
Contact information
Practice address
141 DAYTON ST, SUITE 201, RIDGEWOOD, NJ 07450-4496
(201) 447-6468
(201) 447-3189
Mailing address
141 DAYTON ST, SUITE 201, RIDGEWOOD, NJ 07450-4496
(201) 447-6468
(201) 447-3189
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA03896800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1084470
AETNA HMO GROUP #
NJ
05
—
3240509
—
NJ
01
—
7117748
AETNA PPO GROUP #
NJ
01
—
CM1037
RAILROAD MCR GROUP #
NJ
Enumeration date
06/28/2007
Last updated
04/20/2008
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