Healthcare Provider Details

I. General information

NPI: 1134372329
Provider Name (Legal Business Name): CAROLINE ROSE EISENBERG R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 BERLIN CROSS KEYS RD
BERLIN NJ
08009
US

IV. Provider business mailing address

226 ROOSEVELT BLVD
BERLIN NJ
08009
US

V. Phone/Fax

Practice location:
  • Phone: 856-470-0665
  • Fax: 856-767-3867
Mailing address:
  • Phone: 856-470-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberCDR- 01025437
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: