Healthcare Provider Details

I. General information

NPI: 1457654691
Provider Name (Legal Business Name): JENNIFER WINDISH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 WITHERSPOON ST
PRINCETON NJ
08540-3211
US

IV. Provider business mailing address

253 WITHERSPOON ST
PRINCETON NJ
08540-3211
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1039954
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: