Provider Demographics
NPI:1588323653
Name:ENGELS, GRACE (RD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ENGELS
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 1:58 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:BRANCHVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07826-6064
Mailing Address - Country:US
Mailing Address - Phone:973-459-9020
Mailing Address - Fax:
Practice Address - Street 1:58 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:BRANCHVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07826-6064
Practice Address - Country:US
Practice Address - Phone:973-459-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86080267133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86080267OtherCOMMISSION ON DIETETIC REGISTRATION