Healthcare Provider Details

I. General information

NPI: 1649195496
Provider Name (Legal Business Name): MARY ELIZABETH DZIBELA NTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ELIZABETH DZIBELA BARNHART NTP

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 N KINDERKAMACK RD
MONTVALE NJ
07645-1312
US

IV. Provider business mailing address

93 N KINDERKAMACK RD
MONTVALE NJ
07645-1312
US

V. Phone/Fax

Practice location:
  • Phone: 203-564-6505
  • Fax:
Mailing address:
  • Phone: 203-564-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: