Provider Demographics
NPI:1538354238
Name:LOGUE, ROSEMARY (RD,MS)
Entity type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:
Last Name:LOGUE
Suffix:
Gender:F
Credentials:RD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9713
Mailing Address - Country:US
Mailing Address - Phone:973-584-9029
Mailing Address - Fax:
Practice Address - Street 1:1738 ROUTE 31 NORTH
Practice Address - Street 2:CENTER FOR ADVANCED WEIGHT LOSS
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-0000
Practice Address - Country:US
Practice Address - Phone:908-735-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ673248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered