Provider Demographics
NPI:1548859283
Name:KNOPOFF, JILL DEBRA (RD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:DEBRA
Last Name:KNOPOFF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 RISING ROCK RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-3501
Mailing Address - Country:US
Mailing Address - Phone:203-550-4386
Mailing Address - Fax:
Practice Address - Street 1:26 RISING ROCK RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-3501
Practice Address - Country:US
Practice Address - Phone:203-550-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
832273133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered