Healthcare Provider Details

I. General information

NPI: 1235767674
Provider Name (Legal Business Name): ELIZABETH GEORGE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CAPITAL WAY STE 356
PENNINGTON NJ
08534-2521
US

IV. Provider business mailing address

66 KING PEN RD
NOTTINGHAM PA
19362-9046
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: