Provider Demographics
NPI:1215437587
Name:HABIBY, SAMAR (MPH, RDN)
Entity type:Individual
Prefix:
First Name:SAMAR
Middle Name:
Last Name:HABIBY
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PRIMROSE CT
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1075
Mailing Address - Country:US
Mailing Address - Phone:201-245-6397
Mailing Address - Fax:
Practice Address - Street 1:10 INDUSTRIAL WAY E STE 104
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3333
Practice Address - Country:US
Practice Address - Phone:732-389-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
NJ800339133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education