MEDICARE: JEFFREY D KNISPEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	038731	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710983036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY D KNISPEL M.D.

Provider Business Mailing Address
First Line	:	170 MOUNT PLEASANT RD STE 201
Second Line	:
City	:	NEWTOWN
State	:	CT
Zip	:	06470-1408
Country	:	US
Telephone Number	:	203-792-4151
Fax Number	:	203-792-4155

Provider Business Practice Location Address
First Line	:	170 MOUNT PLEASANT RD STE 201
Second Line	:
City	:	NEWTOWN
State	:	CT
Zip	:	06470-1408
Country	:	US
Telephone Number	:	203-792-4151
Fax Number	:	203-792-4155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/26/2019

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