Healthcare Provider Details

I. General information

NPI: 1477609139
Provider Name (Legal Business Name): MRS. SUZANNE MARIE MOGAVERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD BUILDING 6 SUITE 84
HAZLET NJ
07730-1663
US

IV. Provider business mailing address

1 BETHANY RD BUILDING 6 SUITE 84
HAZLET NJ
07730-1663
US

V. Phone/Fax

Practice location:
  • Phone: 732-335-1800
  • Fax: 732-335-9003
Mailing address:
  • Phone: 732-335-1800
  • Fax: 732-335-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: