Provider Demographics
NPI:1952944845
Name:KIRCHNER, MELISSA CHRISTINE (RD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CHRISTINE
Last Name:KIRCHNER
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 1:31 MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3480
Mailing Address - Country:US
Mailing Address - Phone:732-984-3988
Mailing Address - Fax:
Practice Address - Street 1:208 JACK MARTIN BLVD BLDG C-1
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7770
Practice Address - Country:US
Practice Address - Phone:732-701-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ933145133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered