Healthcare Provider Details

I. General information

NPI: 1417140005
Provider Name (Legal Business Name): KRISTEN MARIE SUGARMAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 WITHERSPOON ST EATING DISORDERS PROGRAM
PRINCETON NJ
08540-3211
US

IV. Provider business mailing address

253 WITHERSPOON ST EATING DISORDERS PROGRAM
PRINCETON NJ
08540-3211
US

V. Phone/Fax

Practice location:
  • Phone: 609-497-4000
  • Fax: 609-497-4412
Mailing address:
  • Phone: 609-497-4000
  • Fax: 609-497-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number912449
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: