Provider Demographics
NPI:1235236704
Name:KOMOSINSKY, MINDY ANN (RD, CDE)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:ANN
Last Name:KOMOSINSKY
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:ANN
Other - Last Name:TUCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:CAPITAL HEALTH SYSTEM NUTRITION SERVICES
Mailing Address - Street 2:750 BRUNSWICK AVE
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-4143
Mailing Address - Country:US
Mailing Address - Phone:609-394-4051
Mailing Address - Fax:609-815-7639
Practice Address - Street 1:CAPITAL HEALTH SYSTEM FOOD & NUTRITION SERVICES
Practice Address - Street 2:750 BRUNSWICK AVENUE
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638
Practice Address - Country:US
Practice Address - Phone:609-394-4051
Practice Address - Fax:609-815-7639
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087949TW3Medicare ID - Type Unspecified