Healthcare Provider Details

I. General information

NPI: 1720610058
Provider Name (Legal Business Name): NINA KNEDLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15065 KUTZTOWN RD STE 400
KUTZTOWN PA
19530-9220
US

IV. Provider business mailing address

15065 KUTZTOWN RD STE 400
KUTZTOWN PA
19530-9220
US

V. Phone/Fax

Practice location:
  • Phone: 484-658-2801
  • Fax: 833-705-2605
Mailing address:
  • Phone: 484-658-2801
  • Fax: 833-705-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV4135
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD482669
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: