Organization
KSRD NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA L STELMACH R.D. (OWNER)
(973) 518-2674
Entity
Organization
Contact information
Practice address
600 VALLEY RD, SUITE LLR1, WAYNE, NJ 07470-3535
(973) 518-2674
Mailing address
600 VALLEY RD, SUITE LLR1, WAYNE, NJ 07470-3535
(973) 518-2674
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
962920
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12413713
CAQH
NJ
01
—
1699002113
NPI, INDIVIDUAL
NJ
Enumeration date
08/08/2012
Last updated
06/22/2015
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