Healthcare Provider Details

I. General information

NPI: 1447461033
Provider Name (Legal Business Name): NORTH JERSEY NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 EXETER LN
MORRISTOWN NJ
07960-6382
US

IV. Provider business mailing address

15 EXETER LN
MORRISTOWN NJ
07960-6382
US

V. Phone/Fax

Practice location:
  • Phone: 973-537-7791
  • Fax: 973-538-7566
Mailing address:
  • Phone: 973-537-7791
  • Fax: 973-538-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number709515
License Number StateNJ

VIII. Authorized Official

Name: MADELINE CICERO
Title or Position: OWNER
Credential: MS,RD,CDE
Phone: 973-538-7791