Healthcare Provider Details

I. General information

NPI: 1972919884
Provider Name (Legal Business Name): AMY L. WITTERSCHEIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N BROAD ST
ELIZABETH NJ
07208-3300
US

IV. Provider business mailing address

234 HILLSIDE AVE
SPRINGFIELD NJ
07081-2810
US

V. Phone/Fax

Practice location:
  • Phone: 908-436-1002
  • Fax: 908-436-1109
Mailing address:
  • Phone: 845-649-2491
  • Fax: 908-436-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: