Healthcare Provider Details

I. General information

NPI: 1194766303
Provider Name (Legal Business Name): KRISTIN JILL REISINGER MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 PALISADE AVE
JERSEY CITY NJ
07306-1121
US

IV. Provider business mailing address

353 7TH ST APT 2
JERSEY CITY NJ
07302-1837
US

V. Phone/Fax

Practice location:
  • Phone: 201-795-8303
  • Fax:
Mailing address:
  • Phone: 201-795-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number948083
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: