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NPI Code Detail

MEDICARE: DAWN PONDISH R.D.

MEDICARE: DAWN PONDISH R.D.
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
1133V00000XRegistered Dietitian008785NY
2133V00000XRegistered Dietitian720841NJ

General Provider Information

NPI Number : 1083911838
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN PONDISH R.D.
Provider Business Mailing Address
First Line : 1 WOODSIDE DR
Second Line :
City : TABERNACLE
State : NJ
Zip : 08088-9148
Country : US
Telephone Number : 808-212-6062
Fax Number :
Provider Business Practice Location Address
First Line : 3458 NEELY RD STE 2C34
Second Line :
City : JOINT BASE MDL
State : NJ
Zip : 08641-5312
Country : US
Telephone Number : 808-212-6062
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2011
Last Update Date : 07/21/2022

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