Healthcare Provider Details

I. General information

NPI: 1790833929
Provider Name (Legal Business Name): MARY CHRISTINA FRIESZ PHD, RD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/09/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROUTE 22 STE 2000
BRIDGEWATER NJ
08807-2943
US

IV. Provider business mailing address

10 NURSERY LN
MIDDLESEX NJ
08846-1572
US

V. Phone/Fax

Practice location:
  • Phone: 954-296-6300
  • Fax: 908-450-6236
Mailing address:
  • Phone: 954-296-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number714113
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: