Provider Demographics
NPI:1235738873
Name:MORGAN, ALEXANDER W (DTR)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:W
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9658
Mailing Address - Country:US
Mailing Address - Phone:856-562-2253
Mailing Address - Fax:
Practice Address - Street 1:100 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9658
Practice Address - Country:US
Practice Address - Phone:856-562-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered