Healthcare Provider Details

I. General information

NPI: 1639592322
Provider Name (Legal Business Name): KATHLEEN ANN GARRIQUES MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RIVERVIEW AVE
COLUMBIA NJ
07832-2030
US

IV. Provider business mailing address

11 RIVERVIEW AVE
COLUMBIA NJ
07832-2030
US

V. Phone/Fax

Practice location:
  • Phone: 908-475-2498
  • Fax: 908-475-2498
Mailing address:
  • Phone: 908-475-2498
  • Fax: 908-475-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number720234
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number720234
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number720234
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number720234
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number720234
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: