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NPI Code Detail

MEDICARE: MRS. LESLEY GAIL KELNER RD, LDN, CDE

MEDICARE:  MRS. LESLEY GAIL KELNER  RD, LDN, CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDN000589PA

General Provider Information

NPI Number : 1003092123
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LESLEY GAIL KELNER RD, LDN, CDE
Provider Business Mailing Address
First Line : 425 BRIGGS RD
Second Line :
City : LANGHORNE
State : PA
Zip : 19047-8228
Country : US
Telephone Number : 215-741-4680
Fax Number : 215-741-4683
Provider Business Practice Location Address
First Line : 2346 TRENTON RD
Second Line : SUITE C
City : LEVITTOWN
State : PA
Zip : 19056-1423
Country : US
Telephone Number : 215-741-4680
Fax Number : 215-741-4683
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2008
Last Update Date : 01/18/2008

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Directions to “ MRS. LESLEY GAIL KELNER RD, LDN, CDE” Practice Location

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