Provider Demographics
NPI:1093445520
Name:CAMPBELL-TATULLI, MEAGHAN E (RDN)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:E
Last Name:CAMPBELL-TATULLI
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 1:2185 LEMOINE AVE STE 1G
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6030
Mailing Address - Country:US
Mailing Address - Phone:877-959-8180
Mailing Address - Fax:866-535-3188
Practice Address - Street 1:2185 LEMOINE AVE STE 1G
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6030
Practice Address - Country:US
Practice Address - Phone:877-959-8180
Practice Address - Fax:866-535-3188
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ727767133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ727767OtherRDN REGISTRATION