Provider Demographics
NPI:1578050217
Name:O'BRIEN, STACY (RDN)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7604
Mailing Address - Country:US
Mailing Address - Phone:973-567-3688
Mailing Address - Fax:973-567-3688
Practice Address - Street 1:68 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7604
Practice Address - Country:US
Practice Address - Phone:973-567-3688
Practice Address - Fax:973-567-3688
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered