Healthcare Provider Details

I. General information

NPI: 1447873492
Provider Name (Legal Business Name): AMANDA CIPRICH MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EASTON AVE STE 26 #248
SOMERSET NJ
08873-1760
US

IV. Provider business mailing address

103 CREST DR
SUMMIT NJ
07901
US

V. Phone/Fax

Practice location:
  • Phone: 908-420-1856
  • Fax:
Mailing address:
  • Phone: 908-420-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: