Provider Demographics
NPI:1568584167
Name:ROSCIOLI, KRISTEN N (RD, CSP, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:ROSCIOLI
Suffix:
Gender:F
Credentials:RD, CSP, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 N 28TH ST
Mailing Address - Street 2:108
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1732
Mailing Address - Country:US
Mailing Address - Phone:610-529-7966
Mailing Address - Fax:
Practice Address - Street 1:1740 SOUTH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1514
Practice Address - Country:US
Practice Address - Phone:215-735-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003698133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric