Healthcare Provider Details

I. General information

NPI: 1457388159
Provider Name (Legal Business Name): LORRAINE MATTHEWS-ANTOSIEWICZ R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 AMBOY AVE
EDISON NJ
08837-3224
US

IV. Provider business mailing address

80 HIGHLAND AVE
METUCHEN NJ
08840-1913
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-1149
  • Fax: 732-494-8567
Mailing address:
  • Phone: 732-494-1149
  • Fax: 732-494-8567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: