Provider Demographics
NPI:1215173513
Name:RIEDEL, JACQUELINE (DO)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LAUREL OAK RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4453
Mailing Address - Country:US
Mailing Address - Phone:856-344-7360
Mailing Address - Fax:856-783-1403
Practice Address - Street 1:165 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3123
Practice Address - Country:US
Practice Address - Phone:856-384-0210
Practice Address - Fax:856-384-0218
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08820000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine