Provider Demographics
NPI:1336234285
Name:BROADT, BARBARA D (RD)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:D
Last Name:BROADT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MANASQUAN RD
Mailing Address - Street 2:
Mailing Address - City:WARETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08758-2663
Mailing Address - Country:US
Mailing Address - Phone:609-971-2758
Mailing Address - Fax:609-971-2758
Practice Address - Street 1:305 MEDICAL GROUP 3458 NEELY ROAD
Practice Address - Street 2:
Practice Address - City:MCGUIRE AFB
Practice Address - State:NJ
Practice Address - Zip Code:08641
Practice Address - Country:US
Practice Address - Phone:609-754-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered