MEDICARE: MEAGAN BUTLER 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
1	133V00000X	Registered Dietitian	1000848	NJ

General Provider Information

NPI Number	:	1285884619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN BUTLER RD

Provider Business Mailing Address
First Line	:	89 FOREST AVE
Second Line	:
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1448
Country	:	US
Telephone Number	:	908-723-0691
Fax Number	:	908-935-2212

Provider Business Practice Location Address
First Line	:	89 FOREST AVE
Second Line	:
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1448
Country	:	US
Telephone Number	:	908-723-0691
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	06/02/2021

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