Provider Demographics
NPI:1609654607
Name:SIMON, CATHERINE ALLISON (RD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ALLISON
Last Name:SIMON
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 1:748 CRESCENT PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2304
Mailing Address - Country:US
Mailing Address - Phone:908-456-5343
Mailing Address - Fax:
Practice Address - Street 1:748 CRESCENT PKWY
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2304
Practice Address - Country:US
Practice Address - Phone:908-456-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5063133V00000X
86209588133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered