Healthcare Provider Details

I. General information

NPI: 1447982400
Provider Name (Legal Business Name): BURCU BB BEBA CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 OAK HILL RD
BRANCHBURG NJ
08853-4222
US

IV. Provider business mailing address

17 OAK HILL RD
BRANCHBURG NJ
08853-4222
US

V. Phone/Fax

Practice location:
  • Phone: 630-487-6967
  • Fax:
Mailing address:
  • Phone: 630-487-6967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number002982
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX5432
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: