Provider Demographics
NPI:1104198415
Name:GEORGE, JOSHUA BRIDDES (RD)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:BRIDDES
Last Name:GEORGE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5736
Mailing Address - Country:US
Mailing Address - Phone:609-332-0143
Mailing Address - Fax:
Practice Address - Street 1:24 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5736
Practice Address - Country:US
Practice Address - Phone:609-332-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1015407133V00000X
NJ1015407133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered