Healthcare Provider Details

I. General information

NPI: 1336310200
Provider Name (Legal Business Name): MS. KARA MCCONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 NEWARK POMPTON TPKE
RIVERDALE NJ
07457
US

IV. Provider business mailing address

18 NEWARK POMPTON TPKE
RIVERDALE NJ
07457
US

V. Phone/Fax

Practice location:
  • Phone: 973-616-4555
  • Fax: 973-616-3430
Mailing address:
  • Phone: 973-616-4555
  • Fax: 973-616-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number00857936
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: