Provider Demographics
NPI:1558754465
Name:CANDELA, ELIZABETH (MA, RDN, ACSM EP(C))
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:CANDELA
Suffix:
Gender:F
Credentials:MA, RDN, ACSM EP(C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ARDSLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1702
Mailing Address - Country:US
Mailing Address - Phone:973-852-3335
Mailing Address - Fax:
Practice Address - Street 1:2 ARDSLEY RD
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1702
Practice Address - Country:US
Practice Address - Phone:973-852-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1080483133NN1002X, 133V00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ47-2170369OtherEIN