Healthcare Provider Details

I. General information

NPI: 1952944845
Provider Name (Legal Business Name): MELISSA CHRISTINE KIRCHNER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 JACK MARTIN BLVD BLDG C-1
BRICK NJ
08724-7770
US

IV. Provider business mailing address

31 MEADOWS LN
OCEAN NJ
07712-3480
US

V. Phone/Fax

Practice location:
  • Phone: 732-701-4848
  • Fax:
Mailing address:
  • Phone: 732-984-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number933145
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: