Provider Demographics
NPI:1073950556
Name:FALCO, ERIN KELLY (RD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:KELLY
Last Name:FALCO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LEROY PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1711
Mailing Address - Country:US
Mailing Address - Phone:732-299-6624
Mailing Address - Fax:
Practice Address - Street 1:31 LEROY PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1711
Practice Address - Country:US
Practice Address - Phone:732-299-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0177194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ368337OtherMEDICARE PTAN