Provider Demographics
NPI:1255650669
Name:O'NEILL, JANE KATHERINE (RD)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:KATHERINE
Last Name:O'NEILL
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:P.O. BOX 336
Mailing Address - Street 2:C/O NEW BRIDGE SERVICES, INC.
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444
Mailing Address - Country:US
Mailing Address - Phone:973-686-2202
Mailing Address - Fax:973-686-2240
Practice Address - Street 1:390 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045
Practice Address - Country:US
Practice Address - Phone:973-316-9333
Practice Address - Fax:973-316-5790
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJREGISTRATIONID#12288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered