Provider Demographics
NPI:1417595273
Name:SMALL-BROOKS, JUNE (MS; RDN)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:SMALL-BROOKS
Suffix:
Gender:F
Credentials:MS; RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-1816
Mailing Address - Country:US
Mailing Address - Phone:631-836-3633
Mailing Address - Fax:
Practice Address - Street 1:5 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-1816
Practice Address - Country:US
Practice Address - Phone:631-836-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
726749133V00000X
NJ726749133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered