Healthcare Provider Details

I. General information

NPI: 1942704861
Provider Name (Legal Business Name): LAUREN ANN FALCONE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 CHAPEL AVE WEST SUITE 200
CHERRY HILL NJ
08002
US

IV. Provider business mailing address

2211 CHAPEL AVE WEST SUITE 200
CHERRY HILL NJ
08002
US

V. Phone/Fax

Practice location:
  • Phone: 856-665-2017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: