Provider Demographics
NPI:1003366204
Name:CAMPANILE, HEATHER (MS, RD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CAMPANILE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-2010
Mailing Address - Country:US
Mailing Address - Phone:201-819-8545
Mailing Address - Fax:
Practice Address - Street 1:47 POWELL RD
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-2010
Practice Address - Country:US
Practice Address - Phone:201-819-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ927446133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ927446OtherCDR