Healthcare Provider Details

I. General information

NPI: 1952001604
Provider Name (Legal Business Name): NATALIE NICOLE KOCH RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 EDGE HILL RD
ABINGTON PA
19001-2609
US

IV. Provider business mailing address

742 BUTTONWOOD AVE
LANGHORNE PA
19047-5905
US

V. Phone/Fax

Practice location:
  • Phone: 267-982-4352
  • Fax:
Mailing address:
  • Phone: 215-539-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN007952
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: