Provider Demographics
NPI:1730795469
Name:ORDONEZ, CRISTIAN (RD)
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:
Last Name:ORDONEZ
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 MANCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1737
Mailing Address - Country:US
Mailing Address - Phone:732-912-4457
Mailing Address - Fax:
Practice Address - Street 1:565 MANCHESTER PL
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1737
Practice Address - Country:US
Practice Address - Phone:732-912-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86168052133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered