Provider Demographics
NPI:1417795014
Name:EBERHART, JOELLE (RDN)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:EBERHART
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 TOWN SQUARE PL # 213
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1756
Mailing Address - Country:US
Mailing Address - Phone:201-878-6199
Mailing Address - Fax:
Practice Address - Street 1:123 TOWN SQUARE PL # 213
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1756
Practice Address - Country:US
Practice Address - Phone:201-878-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86277401133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered