Healthcare Provider Details

I. General information

NPI: 1013345255
Provider Name (Legal Business Name): HEATHER MARY ANDRE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER MARY BEHAN RD

II. Dates (important events)

Enumeration Date: 10/25/2013
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PRINCETON RD
PARLIN NJ
08859-1231
US

IV. Provider business mailing address

40 PRINCETON RD
PARLIN NJ
08859-1231
US

V. Phone/Fax

Practice location:
  • Phone: 973-532-2236
  • Fax:
Mailing address:
  • Phone: 201-741-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1084509
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: