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NPI Code Detail

MEDICARE: CHRISTINA BRECHT RD, LDN

MEDICARE:   CHRISTINA  BRECHT  RD, LDN
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
1133V00000XRegistered DietitianDN001801PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DN001801OTHERPALICENSE NUMBER

General Provider Information

NPI Number : 1558463141
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA BRECHT RD, LDN
Provider Business Mailing Address
First Line : RR 1 BOX 1179
Second Line :
City : CRESCO
State : PA
Zip : 18326-9764
Country : US
Telephone Number : 570-629-9672
Fax Number : 570-629-6355
Provider Business Practice Location Address
First Line : 1 WASHINGTON ST
Second Line :
City : EAST STROUDSBURG
State : PA
Zip : 18301-2816
Country : US
Telephone Number : 570-426-7380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2006
Last Update Date : 07/08/2007

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Directions to “ CHRISTINA BRECHT RD, LDN” Practice Location

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