Provider Demographics
NPI:1235445701
Name:ROTHSCHILD, STACY (RD)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:ROTHSCHILD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DANBURY CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4350
Mailing Address - Country:US
Mailing Address - Phone:201-870-3765
Mailing Address - Fax:
Practice Address - Street 1:110 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4025
Practice Address - Country:US
Practice Address - Phone:201-870-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNOT APPLICABLE133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered