Healthcare Provider Details

I. General information

NPI: 1477019701
Provider Name (Legal Business Name): THERESA BALESTRIERI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CAPITAL WAY STE 356
PENNINGTON NJ
08534-2521
US

IV. Provider business mailing address

2 CAPITAL WAY STE 356
PENNINGTON NJ
08534-2521
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-6000
  • Fax: 609-537-6002
Mailing address:
  • Phone: 609-537-6000
  • Fax: 609-537-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: