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General NPI Number Information
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NPI Number | 1841018868
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Entity Type | Organization
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Legal Business Name | THE EATING DISORDER SPACE, LLC
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 90 MOUNT HOPE RD
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City | ROCKAWAY
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State | NJ
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Zip | 07866-1626
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Country | US
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Telephone | 201-500-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 90 MOUNT HOPE RD
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City | ROCKAWAY
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State | NJ
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Zip | 07866-1626
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER/REGISTERED DIETITIAN
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Name | DAISY HABIB
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Credential | RDN
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Telephone | 973-814-1634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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