Provider Demographics
NPI:1861598963
Name:KNEIFEL, THOMAS W (MD PLLC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:KNEIFEL
Suffix:
Gender:M
Credentials:MD PLLC
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:W
Other - Last Name:KNEIFEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PLLC
Mailing Address - Street 1:50 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1786
Mailing Address - Country:US
Mailing Address - Phone:315-265-3300
Mailing Address - Fax:315-261-5852
Practice Address - Street 1:6119 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3991
Practice Address - Country:US
Practice Address - Phone:315-261-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2230681207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02361833Medicaid
NY02361833Medicaid
X84530Medicare UPIN