Provider Demographics
NPI:1093997124
Name:YOUNG, BETH ANNE (MS, RD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:YOUNG
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 1:9 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6807
Mailing Address - Country:US
Mailing Address - Phone:609-924-7799
Mailing Address - Fax:609-497-0739
Practice Address - Street 1:9 MERCER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6807
Practice Address - Country:US
Practice Address - Phone:609-924-7799
Practice Address - Fax:609-497-0739
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ717875133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered