Provider Demographics
NPI:1386963874
Name:NEW JERSEY CENTER FOR NUTRITION AND DIETETICS LLC
Entity type:Organization
Organization Name:NEW JERSEY CENTER FOR NUTRITION AND DIETETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:732-773-0215
Mailing Address - Street 1:55 MADISON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7337
Mailing Address - Country:US
Mailing Address - Phone:973-944-0171
Mailing Address - Fax:
Practice Address - Street 1:55 MADISON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7337
Practice Address - Country:US
Practice Address - Phone:973-944-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-23
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1034952133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty