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NPI Code Detail

MEDICARE: DIANE M HENDERIKS R.D.

MEDICARE: DIANE M HENDERIKS R.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian857625NJ

General Provider Information

NPI Number : 1639159668
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE M HENDERIKS R.D.
Provider Business Mailing Address
First Line : PO BOX 486
Second Line :
City : OAKHURST
State : NJ
Zip : 07755-0486
Country : US
Telephone Number : 732-922-6269
Fax Number : 732-918-8757
Provider Business Practice Location Address
First Line : 4 HARTFORD DR
Second Line :
City : TINTON FALLS
State : NJ
Zip : 07701-4929
Country : US
Telephone Number : 732-922-6269
Fax Number : 732-918-8757
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2006
Last Update Date : 07/08/2007

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