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General NPI Number Information
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NPI Number | 1639216260
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Entity Type | Individual
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Provider Name | MARILYN MOORE DRISCOLL RD
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 201 LYONS AVENUE
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City | NEWARK
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State | NJ
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Zip | 07112
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Country | US
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Telephone | 973-926-4607
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Fax | 973-926-6288
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Provider Business Mailing Address
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Address Line | 7-24 LAKE STREET
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City | FAIR LAWN
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State | NJ
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Zip | 07410
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Country | US
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Telephone | 201-796-8336
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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 | 719760
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License Number State | NJ
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