Healthcare Provider Details

I. General information

NPI: 1710004726
Provider Name (Legal Business Name): MARY FINCKENOR RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MADISON AVE STE 304
MORRISTOWN NJ
07960-6097
US

IV. Provider business mailing address

6 ONEIDA AVE
ROCKAWAY NJ
07866-1706
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-7230
  • Fax:
Mailing address:
  • Phone: 973-971-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number833073
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number833073
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number833073
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: