Healthcare Provider Details

I. General information

NPI: 1932589355
Provider Name (Legal Business Name): CHRISTINA RANELLE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE 305
MOORESTOWN NJ
08057-3133
US

IV. Provider business mailing address

7000 ATRIUM WAY STE 6
MOUNT LAUREL NJ
08054-3917
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-8660
  • Fax: 856-341-8215
Mailing address:
  • Phone: 856-206-4500
  • 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: