Provider Demographics
NPI:1164840625
Name:BERKOFF, STACEY (MS, RDN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BERKOFF
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MELISSA CT
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 MELISSA CT
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2153
Practice Address - Country:US
Practice Address - Phone:856-765-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2020-05-20
Deactivation Date:2014-12-05
Deactivation Code:
Reactivation Date:2020-05-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered