Provider Demographics
NPI:1578992350
Name:CENTRALNJRD
Entity Type:Organization
Organization Name:CENTRALNJRD
Other - Org Name:CENTRAL NJRD LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANGEETHA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:VASISHTA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:609-630-0017
Mailing Address - Street 1:104 HICKORY CORNER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2460
Mailing Address - Country:US
Mailing Address - Phone:609-336-7700
Mailing Address - Fax:
Practice Address - Street 1:19 KESWICK RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2963
Practice Address - Country:US
Practice Address - Phone:609-336-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ983823261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
983823OtherCOMMISSION OF DIETETIC REGISTRATION