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General NPI Number Information
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NPI Number | 1912560962
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Entity Type | Individual
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Provider Name | NIKITA GEORGE A.A.S., B.SC.
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Gender | Female
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 145 WYCKOFF RD STE 102
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City | EATONTOWN
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State | NJ
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Zip | 07724-1879
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Country | US
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Telephone | 848-208-2721
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Fax | 848-208-2506
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Provider Business Mailing Address
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Address Line | 29 CARMEL WAY
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City | EATONTOWN
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State | NJ
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Zip | 07724-2551
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Country | US
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Telephone | 732-544-2107
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State | NJ
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