MEDICARE: ROCHEL WEBER RD

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	86152268	NJ

General Provider Information

NPI Number	:	1750852836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROCHEL WEBER RD

Provider Business Mailing Address
First Line	:	641 N LAKE DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2570
Country	:	US
Telephone Number	:	732-503-1274
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 N LAKE DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2570
Country	:	US
Telephone Number	:	732-503-1274
Fax Number	:

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

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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Directions to “ ROCHEL WEBER RD” Practice Location

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