Healthcare Provider Details

I. General information

NPI: 1053052415
Provider Name (Legal Business Name): TARA GEIER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 HIGHWAY 35 STE B201
MANASQUAN NJ
08736-1923
US

IV. Provider business mailing address

6 OVERHILL DR
MADISON NJ
07940-1312
US

V. Phone/Fax

Practice location:
  • Phone: 862-579-5098
  • Fax:
Mailing address:
  • Phone: 862-579-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86074646
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86074646
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number86074646
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86074646
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86074646
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: