Healthcare Provider Details

I. General information

NPI: 1225042328
Provider Name (Legal Business Name): ELIANE ORPHA GEREN M.S., R.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

113 DEMPSEY AVE
PRINCETON NJ
08540-3411
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8600
  • Fax: 732-249-9572
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number717521
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: