Provider Demographics
NPI:1861991309
Name:VISITING DIETITIANS OF NEW JERSEY
Entity type:Organization
Organization Name:VISITING DIETITIANS OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TREMBULAK
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:203-984-4296
Mailing Address - Street 1:10 CRESCENT PL
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-1805
Mailing Address - Country:US
Mailing Address - Phone:203-984-4296
Mailing Address - Fax:
Practice Address - Street 1:10 CRESCENT PL
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-1805
Practice Address - Country:US
Practice Address - Phone:203-984-4296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT919079251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare