Healthcare Provider Details

I. General information

NPI: 1053570051
Provider Name (Legal Business Name): ELISSA ANNE BETAR R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RAHWAY AVE
UNION NJ
07083-6634
US

IV. Provider business mailing address

51 MOUNT KEMBLE AVE APT 205
MORRISTOWN NJ
07960-5164
US

V. Phone/Fax

Practice location:
  • Phone: 908-378-1779
  • Fax:
Mailing address:
  • Phone: 973-714-7951
  • 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: