Healthcare Provider Details

I. General information

NPI: 1730056425
Provider Name (Legal Business Name): ANTHONY RICARDO ESCOBAR REGISTERED DIETITIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 RINGWOOD AVE APT A-7
POMPTON LAKES NJ
07442-2032
US

IV. Provider business mailing address

221 RINGWOOD AVE APT A-7
POMPTON LAKES NJ
07442-2032
US

V. Phone/Fax

Practice location:
  • Phone: 862-345-4067
  • Fax: 862-345-4067
Mailing address:
  • Phone: 862-345-4067
  • Fax: 862-345-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86109371
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: