Healthcare Provider Details

I. General information

NPI: 1902306434
Provider Name (Legal Business Name): SAMANTHA ECKARDT RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CAPITAL WAY STE 356
PENNINGTON NJ
08534-2521
US

IV. Provider business mailing address

211 S 9TH ST STE 402
PHILADELPHIA PA
19107-6810
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-6000
  • Fax: 609-537-6002
Mailing address:
  • Phone: 215-955-0020
  • Fax: 215-503-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN006474
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: