MEDICARE: MRS. MELISSA CHRISTINE KIRCHNER 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	933145	NJ

General Provider Information

NPI Number	:	1952944845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA CHRISTINE KIRCHNER RD

Provider Business Mailing Address
First Line	:	31 MEADOWS LN
Second Line	:
City	:	OCEAN
State	:	NJ
Zip	:	07712-3480
Country	:	US
Telephone Number	:	732-984-3988
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 JACK MARTIN BLVD BLDG C-1
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-7770
Country	:	US
Telephone Number	:	732-701-4848
Fax Number	:

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

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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