Healthcare Provider Details

I. General information

NPI: 1013184480
Provider Name (Legal Business Name): MARISOL VAZQUEZ RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISOL CARDONA

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E HALSEY RD # 321
PARSIPPANY NJ
07054-3713
US

IV. Provider business mailing address

90 E HALSEY RD STE 321
PARSIPPANY NJ
07054-3713
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-7495
  • Fax: 973-695-1655
Mailing address:
  • Phone: 973-744-7495
  • Fax: 973-771-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number946877
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: