Provider Demographics
NPI:1609103647
Name:NEWMAN, TERRY (RD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ATLANTIC AVE
Mailing Address - Street 2:SUITE #15
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1352
Mailing Address - Country:US
Mailing Address - Phone:732-292-9800
Mailing Address - Fax:732-223-1587
Practice Address - Street 1:200 ATLANTIC AVE
Practice Address - Street 2:SUITE #15
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1352
Practice Address - Country:US
Practice Address - Phone:732-292-9800
Practice Address - Fax:732-223-1587
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ706228133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered