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NPI Code Detail

MEDICARE: HEIDI M ELICH MS, RD

MEDICARE: HEIDI M ELICH MS, RD
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 Dietitian712367NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1578504OTHERNJAETNA
21039742OTHERNJHORIZON NJ HEALTH
31262939002OTHERNJCIGNA

General Provider Information

NPI Number : 1164486205
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI M ELICH MS, RD
Provider Business Mailing Address
First Line : 1001 CENTER ST
Second Line :
City : LITTLE EGG HARBOR TWP
State : NJ
Zip : 08087-1347
Country : US
Telephone Number : 609-294-1988
Fax Number : 609-296-6059
Provider Business Practice Location Address
First Line : 1001 CENTER ST
Second Line :
City : LITTLE EGG HARBOR TWP
State : NJ
Zip : 08087-1347
Country : US
Telephone Number : 609-294-1988
Fax Number : 609-296-6059
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 07/08/2007

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