Provider Demographics
NPI:1609237676
Name:PRELL, GENNA (RD)
Entity Type:Individual
Prefix:MRS
First Name:GENNA
Middle Name:
Last Name:PRELL
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 1:121 WOODCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7935
Mailing Address - Country:US
Mailing Address - Phone:551-427-1504
Mailing Address - Fax:
Practice Address - Street 1:174 UNION ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4498
Practice Address - Country:US
Practice Address - Phone:201-652-5114
Practice Address - Fax:201-652-6253
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1013698133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered