Provider Demographics
NPI:1336677301
Name:LIPTAK KING, CAITLYN (RDN)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:LIPTAK KING
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WYCKOFF ROAD, SUITE 4200
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-7632
Mailing Address - Country:US
Mailing Address - Phone:732-935-7143
Mailing Address - Fax:732-935-7245
Practice Address - Street 1:200 WYCKOFF ROAD, SUITE 4200
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-7632
Practice Address - Country:US
Practice Address - Phone:732-935-7143
Practice Address - Fax:732-935-7245
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86002881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1336677301Medicaid