Provider Demographics
NPI:1578938437
Name:DIGIACOMO, CRYSTAL (MS, RD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:DIGIACOMO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:WOESSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:1034 PROSPECT LN
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-2218
Mailing Address - Country:US
Mailing Address - Phone:609-805-7082
Mailing Address - Fax:
Practice Address - Street 1:1034 PROSPECT LN
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-2218
Practice Address - Country:US
Practice Address - Phone:609-805-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered