Healthcare Provider Details

I. General information

NPI: 1588727218
Provider Name (Legal Business Name): BINDU JENVEJA RD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 PETTIT PL
PRINCETON NJ
08540-7645
US

IV. Provider business mailing address

83 PETTIT PL
PRINCETON NJ
08540-7645
US

V. Phone/Fax

Practice location:
  • Phone: 609-688-9376
  • Fax: 609-688-9376
Mailing address:
  • Phone: 609-688-9376
  • Fax: 609-688-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberCERTIFICATION#722370
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: