=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619455888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACLYN MARIE MURPHY RDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2018
-----------------------------------------------------
Last Update Date | 07/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 VALLEY HEALTH PLZ
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-634-5371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 BARBARA RD
-----------------------------------------------------
City | DUMONT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07628-1402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-981-5711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 86093049
-----------------------------------------------------
License Number State |
-----------------------------------------------------