Provider Demographics
NPI:1609945393
Name:CLINTON, PAULA L (DTR)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:L
Last Name:CLINTON
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08853-4286
Mailing Address - Country:US
Mailing Address - Phone:908-336-0372
Mailing Address - Fax:
Practice Address - Street 1:701 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3550
Practice Address - Country:US
Practice Address - Phone:908-346-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ105846OtherAMERIGROUP PROVIDER #