Healthcare Provider Details

I. General information

NPI: 1720184807
Provider Name (Legal Business Name): LISA E KNOFLICEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA E JOY

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 CHESTNUT ST
PHILADELPHIA PA
19107-4131
US

IV. Provider business mailing address

1233 LOCUST ST FL 3
PHILADELPHIA PA
19107-5400
US

V. Phone/Fax

Practice location:
  • Phone: 215-525-8600
  • Fax: 215-567-1012
Mailing address:
  • Phone: 215-985-4448
  • Fax: 215-985-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD426771
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: