Provider Demographics
NPI:1376989111
Name:DE PAIVA COUGHLIN, GIRLENE BARBON (RD)
Entity Type:Individual
Prefix:MRS
First Name:GIRLENE
Middle Name:BARBON
Last Name:DE PAIVA COUGHLIN
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 1:401 US HIGHWAY 22
Mailing Address - Street 2:APT. 50C
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3863
Mailing Address - Country:US
Mailing Address - Phone:908-756-6963
Mailing Address - Fax:
Practice Address - Street 1:500 NEWARK AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-222-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered