Healthcare Provider Details

I. General information

NPI: 1316267545
Provider Name (Legal Business Name): ALLISON E JANISCH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LENHOME DR
CRANFORD NJ
07016-2956
US

IV. Provider business mailing address

25 LENHOME DR
CRANFORD NJ
07016-2956
US

V. Phone/Fax

Practice location:
  • Phone: 607-351-9044
  • Fax:
Mailing address:
  • Phone: 607-351-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDN0000405
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0000405
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003912
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN0000405
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: