Healthcare Provider Details

I. General information

NPI: 1255806857
Provider Name (Legal Business Name): ELLEN SAGAN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 MOUNTAIN AVE
HACKETTSTOWN NJ
07840-2407
US

IV. Provider business mailing address

PO BOX 95000, LB#7550
PHILADELPHIA PA
19195-7550
US

V. Phone/Fax

Practice location:
  • Phone: 908-852-6400
  • Fax:
Mailing address:
  • Phone: 844-361-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number721168
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: