Provider Demographics
NPI:1114240637
Name:GISSER, JUDITH (CNS, CWC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GISSER
Suffix:
Gender:F
Credentials:CNS, CWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OSWEGO AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1401
Mailing Address - Country:US
Mailing Address - Phone:973-625-3169
Mailing Address - Fax:
Practice Address - Street 1:639 STATE HIGHWAY NUMBER 53
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950
Practice Address - Country:US
Practice Address - Phone:973-625-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist