Healthcare Provider Details

I. General information

NPI: 1578980033
Provider Name (Legal Business Name): KATRINA KNAPP D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2014
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HOLLEY LN
PROSPECT CT
06712-1483
US

IV. Provider business mailing address

22 HOLLEY LN
PROSPECT CT
06712-1483
US

V. Phone/Fax

Practice location:
  • Phone: 203-808-6071
  • Fax:
Mailing address:
  • Phone: 203-808-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number274262
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: