Provider Demographics
NPI:1073395745
Name:WINTER, FRAIDEL (RDN)
Entity Type:Individual
Prefix:
First Name:FRAIDEL
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2133
Mailing Address - Country:US
Mailing Address - Phone:845-570-3241
Mailing Address - Fax:
Practice Address - Street 1:2 MARYLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2133
Practice Address - Country:US
Practice Address - Phone:845-570-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered