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General NPI Number Information
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NPI Number | 1063567287
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Entity Type | Individual
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Provider Name | BARBARA BERGEN MINTZ RD
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 333 BLOOMFIELD AVE
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City | CALDWELL
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State | NJ
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Zip | 07006-5166
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Country | US
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Telephone | 12-618-1705
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Fax |
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Provider Business Mailing Address
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Address Line | 11 KNOLLWOOD TER
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City | CALDWELL
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State | NJ
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Zip | 07006-5808
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Country | US
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Telephone | 201-618-1705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 842413
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License Number State | NJ
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