Provider Demographics
NPI:1538467535
Name:CORRELL, CHEUNG KO (MBA, RD)
Entity Type:Individual
Prefix:
First Name:CHEUNG
Middle Name:KO
Last Name:CORRELL
Suffix:
Gender:F
Credentials:MBA, RD
Other - Prefix:
Other - First Name:CHEUNG
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBA, RD
Mailing Address - Street 1:304 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2065
Mailing Address - Country:US
Mailing Address - Phone:203-400-0506
Mailing Address - Fax:
Practice Address - Street 1:304 LINDEN ST
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2065
Practice Address - Country:US
Practice Address - Phone:203-400-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ873640133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered