Healthcare Provider Details

I. General information

NPI: 1215173513
Provider Name (Legal Business Name): JACQUELINE RIEDEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 S HADDON AVE STE 4
HADDONFIELD NJ
08033-1882
US

IV. Provider business mailing address

3 S HADDON AVE STE 4
HADDONFIELD NJ
08033-1882
US

V. Phone/Fax

Practice location:
  • Phone: 856-531-7241
  • Fax: 856-804-9720
Mailing address:
  • Phone: 856-531-7241
  • Fax: 856-815-9720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08820000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: