Provider Demographics
NPI:1578949020
Name:DIETETIC CARE PRACTICE LLC
Entity Type:Organization
Organization Name:DIETETIC CARE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANETA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RESKA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:201-952-4037
Mailing Address - Street 1:110-2907 RIVER DR SOUTH
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310
Mailing Address - Country:US
Mailing Address - Phone:201-952-4037
Mailing Address - Fax:
Practice Address - Street 1:110-2907 RIVER DR SOUTH
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310
Practice Address - Country:US
Practice Address - Phone:201-952-4037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty