Provider Demographics
NPI:1841985280
Name:ERICKA KOFFEL NUTRITION, LLC
Entity type:Organization
Organization Name:ERICKA KOFFEL NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:LINDSAY
Authorized Official - Last Name:KOFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN, CHWC
Authorized Official - Phone:609-903-1866
Mailing Address - Street 1:401 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BALLY
Mailing Address - State:PA
Mailing Address - Zip Code:19503-9684
Mailing Address - Country:US
Mailing Address - Phone:609-903-1866
Mailing Address - Fax:
Practice Address - Street 1:2925 WILLIAM PENN HWY STE 306
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5283
Practice Address - Country:US
Practice Address - Phone:484-554-0124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty