Provider Demographics
NPI:1063567287
Name:MINTZ, BARBARA BERGEN (RD)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:BERGEN
Last Name:MINTZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11 KNOLLWOOD TER
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5808
Mailing Address - Country:US
Mailing Address - Phone:201-618-1705
Mailing Address - Fax:
Practice Address - Street 1:333 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5166
Practice Address - Country:US
Practice Address - Phone:012-618-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ842413133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ238897OtherAMERIGROUP
NJ3309246OtherAETNA US HEALTH
NJHORIZON BLUE CROSSOther223452311
NJUNITED HEALTH CAREOther215962704
NJOXFORD HEALTH PLANOtherP3030430