Healthcare Provider Details

I. General information

NPI: 1972393320
Provider Name (Legal Business Name): BRANDON ESCANDON RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE FL 3
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD BLDG 2, STE 220
RED BANK NJ
07701-5688
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5329
  • Fax: 551-996-0115
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86299663
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: