Healthcare Provider Details

I. General information

NPI: 1346062726
Provider Name (Legal Business Name): ERIN ALEXANDER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVENUE SUITE 305A
MOORESTOWN NJ
08057
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-341-8250
  • Fax:
Mailing address:
  • Phone: 856-291-8660
  • Fax: 856-291-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86090058
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: