Provider Demographics
NPI:1326172818
Name:KNOBEL, STEPHANIE M
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:KNOBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 KATHLYN AVE
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-9712
Mailing Address - Country:US
Mailing Address - Phone:315-331-1700
Mailing Address - Fax:
Practice Address - Street 1:703 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1845
Practice Address - Country:US
Practice Address - Phone:315-331-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005003133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist