Provider Demographics
NPI:1245698729
Name:ROONEY, LAUREN (RD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROONEY
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 1:14 JACOBS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-1704
Mailing Address - Country:US
Mailing Address - Phone:856-380-2760
Mailing Address - Fax:
Practice Address - Street 1:15000 MIDLANTIC DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1573
Practice Address - Country:US
Practice Address - Phone:856-380-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ994761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered