Healthcare Provider Details

I. General information

NPI: 1639347800
Provider Name (Legal Business Name): MEJATT DIETETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 RESERVOIR RD
HACKETTSTOWN NJ
07840-5647
US

IV. Provider business mailing address

48 RESERVOIR RD
HACKETTSTOWN NJ
07840-5647
US

V. Phone/Fax

Practice location:
  • Phone: 908-303-7949
  • Fax: 908-979-9797
Mailing address:
  • Phone: 908-303-7949
  • Fax: 908-979-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number00890332
License Number StateNJ

VIII. Authorized Official

Name: MRS. ESTHER F ADESINA
Title or Position: PRESIDENT, REGISTERED DIETITINA
Credential: MS, RD
Phone: 908-303-7949