Provider Demographics
NPI:1104926088
Name:SALAS, CAROL B (MS, RD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:SALAS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 KATHY ST
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1605
Mailing Address - Country:US
Mailing Address - Phone:732-821-0911
Mailing Address - Fax:732-940-2670
Practice Address - Street 1:28 KATHY ST
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1605
Practice Address - Country:US
Practice Address - Phone:732-821-0911
Practice Address - Fax:732-940-2670
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
110631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2075442OtherAETNA PROVIDER
NJ5580532OtherCIGNA PROVIDER
NJP3156966OtherOXFORD PROVIDER
NJ5580532OtherCIGNA PROVIDER