Healthcare Provider Details

I. General information

NPI: 1982321105
Provider Name (Legal Business Name): ERICKA LINDSAY KOFFEL RD, LDN, CHWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DOGWOOD ST
BALLY PA
19503-9684
US

IV. Provider business mailing address

401 DOGWOOD ST
BALLY PA
19503-9684
US

V. Phone/Fax

Practice location:
  • Phone: 609-903-1866
  • Fax:
Mailing address:
  • Phone: 609-903-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN007475
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: