MEDICARE: DEBRA A. BLAIR,R.D., C.D.E., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	14518	NJ
2	133NN1002X	Nutrition Education Nutritionist	14518	NJ
3	133VN1004X	Pediatric Nutrition Registered Dietitian	14518	NJ
4	133VN1005X	Renal Nutrition Registered Dietitian	14518	NJ
5	133VN1006X	Metabolic Nutrition Registered Dietitian	14518	NJ
6	133V00000X	Registered Dietitian	14518	NJ

General Provider Information

NPI Number	:	1033449228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA A. BLAIR,R.D., C.D.E., LLC

Provider Business Mailing Address
First Line	:	2911 ROUTE 88
Second Line	:	SUITE 4
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-2871
Country	:	US
Telephone Number	:	732-746-3708
Fax Number	:	732-899-4074

Provider Business Practice Location Address
First Line	:	2911 ROUTE 88
Second Line	:	SUITE 4
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-2871
Country	:	US
Telephone Number	:	732-746-3708
Fax Number	:	732-899-4074

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEBRA ANNE BLAIR
Credential	:	R.D., C.D.E..
Telephone Number	:	732-746-3708

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/11/2010

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