Provider Demographics
NPI:1518375401
Name:SCHWARTZ, VICKI
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:VICKI
Other - Middle Name:S
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CNSC
Mailing Address - Street 1:101 S PLAZA PL
Mailing Address - Street 2:PLAZA CONDO, UNIT 804
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-5649
Mailing Address - Country:US
Mailing Address - Phone:610-864-0272
Mailing Address - Fax:
Practice Address - Street 1:101 S PLAZA PL
Practice Address - Street 2:PLAZA CONDO, UNIT 804
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-5649
Practice Address - Country:US
Practice Address - Phone:610-864-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133V00000X133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
424990OtherREGISTERED DIETITIAN NUMBER