Provider Demographics
NPI:1164705067
Name:GREENSPAN, STEPHANIE PAMELA (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:PAMELA
Last Name:GREENSPAN
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 1:222 CEDAR LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4314
Mailing Address - Country:US
Mailing Address - Phone:201-530-1900
Mailing Address - Fax:201-530-9300
Practice Address - Street 1:222 CEDAR LN
Practice Address - Street 2:SUITE 201
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4314
Practice Address - Country:US
Practice Address - Phone:201-530-1900
Practice Address - Fax:201-530-9300
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1007089133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered