Provider Demographics
NPI:1588727218
Name:JENVEJA, BINDU (RD,CDE)
Entity type:Individual
Prefix:MRS
First Name:BINDU
Middle Name:
Last Name:JENVEJA
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 PETTIT PL
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7645
Mailing Address - Country:US
Mailing Address - Phone:609-688-9376
Mailing Address - Fax:609-688-9376
Practice Address - Street 1:83 PETTIT PL
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7645
Practice Address - Country:US
Practice Address - Phone:609-688-9376
Practice Address - Fax:609-688-9376
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCERTIFICATION#722370133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ054167Medicare ID - Type UnspecifiedMEDICARE
NJ2228818Medicare UPIN
NJ197-84-63Medicare UPIN
NJ6965628-002Medicare UPIN
NJP2552039Medicare UPIN