Provider Demographics
NPI:1144574203
Name:PAGELS, KENNETH R (RD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:PAGELS
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 1:1060 PARVIN MILL RD
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4168
Mailing Address - Country:US
Mailing Address - Phone:856-503-0696
Mailing Address - Fax:
Practice Address - Street 1:1060 PARVIN MILL RD
Practice Address - Street 2:
Practice Address - City:PITTSGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08318-4168
Practice Address - Country:US
Practice Address - Phone:856-503-0696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86008770133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered