Provider Demographics
NPI:1629031703
Name:GENETTA, CHARLOTTE B (RD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:B
Last Name:GENETTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:F
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:835 EDGEPARK DR
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1021
Mailing Address - Country:US
Mailing Address - Phone:856-795-0727
Mailing Address - Fax:
Practice Address - Street 1:401 YOUNG AVE STE 305A
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3133
Practice Address - Country:US
Practice Address - Phone:856-291-8660
Practice Address - Fax:856-291-8661
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095445UNTMedicare ID - Type Unspecified