Healthcare Provider Details

I. General information

NPI: 1982921458
Provider Name (Legal Business Name): MARILYN MCSPIRITT-GUZIO MSRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 PARK ST
MONTCLAIR NJ
07042-2903
US

IV. Provider business mailing address

18 LOUGHEED AVE
WEST CALDWELL NJ
07006-7512
US

V. Phone/Fax

Practice location:
  • Phone: 973-746-0595
  • Fax:
Mailing address:
  • Phone: 973-228-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: