MEDICARE: KIRSTEN MARQUEZ RD, LD/N, CNSC

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
1	133V00000X	Registered Dietitian	ND3796	FL

General Provider Information

NPI Number	:	1689961641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN MARQUEZ RD, LD/N, CNSC

Provider Business Mailing Address
First Line	:	4 SUNNY SLOPE DR
Second Line	:
City	:	WARREN
State	:	NJ
Zip	:	07059-7140
Country	:	US
Telephone Number	:	772-932-1835
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 ROUTE 22 W STE 30
Second Line	:	#1074
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6516
Country	:	US
Telephone Number	:	772-932-1835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	05/30/2024

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