Healthcare Provider Details

I. General information

NPI: 1699606970
Provider Name (Legal Business Name): ROSHAN KAYYAMKATTIL THOMAS RDN, CSG, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 MARTINE AVE
PLAINFIELD NJ
07060-2622
US

IV. Provider business mailing address

1211 MARTINE AVE
PLAINFIELD NJ
07060-2622
US

V. Phone/Fax

Practice location:
  • Phone: 908-244-0586
  • Fax:
Mailing address:
  • Phone: 908-244-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005844
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number886764
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number886764
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: