Provider Demographics
NPI:1508926650
Name:MANGANELLI, BEVERLEY J (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLEY
Middle Name:J
Last Name:MANGANELLI
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NICOLE LN
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4019
Mailing Address - Country:US
Mailing Address - Phone:908-788-0993
Mailing Address - Fax:
Practice Address - Street 1:9100 WESCOTT DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4670
Practice Address - Country:US
Practice Address - Phone:908-237-6920
Practice Address - Fax:908-237-6922
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ064659 Q6EMedicare ID - Type Unspecified