Healthcare Provider Details

I. General information

NPI: 1386963874
Provider Name (Legal Business Name): NEW JERSEY CENTER FOR NUTRITION AND DIETETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2010
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MADISON AVE SUITE 400
MORRISTOWN NJ
07960-7337
US

IV. Provider business mailing address

55 MADISON AVE SUITE 400
MORRISTOWN NJ
07960-7337
US

V. Phone/Fax

Practice location:
  • Phone: 973-944-0171
  • Fax:
Mailing address:
  • Phone: 973-944-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1034952
License Number StateNJ

VIII. Authorized Official

Name: MISS MARISA ANN SWEENEY
Title or Position: REGISTERED DIETITIAN
Credential: RD
Phone: 732-773-0215