Provider Demographics
NPI:1003886904
Name:CZYMMEK, MARTHA (RD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:CZYMMEK
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:PO BOX 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805
Mailing Address - Country:US
Mailing Address - Phone:302-623-7262
Mailing Address - Fax:302-623-7374
Practice Address - Street 1:4701 OGLETOWN-STANTON ROAD
Practice Address - Street 2:SUITE 1213
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4550
Practice Address - Fax:302-623-4554
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN0000135133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP66594Medicare UPIN
DE010143C49Medicare PIN