Provider Demographics
NPI:1427203272
Name:EBNER, ELIZABETH M (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:EBNER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 RIVER RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3273
Mailing Address - Country:US
Mailing Address - Phone:732-933-7776
Mailing Address - Fax:
Practice Address - Street 1:612 RIVER RD
Practice Address - Street 2:SUITE H
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3273
Practice Address - Country:US
Practice Address - Phone:732-933-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered