Healthcare Provider Details

I. General information

NPI: 1306025002
Provider Name (Legal Business Name): JODY LASHEN R.D.,C.D.E
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W BLACKWELL ST REGIONAL DIABETES CENTER
DOVER NJ
07801-2525
US

IV. Provider business mailing address

63 LAKESHORE DR
ROCKAWAY NJ
07866-1405
US

V. Phone/Fax

Practice location:
  • Phone: 973-989-3637
  • Fax:
Mailing address:
  • Phone: 973-627-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number531151
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number531151
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: