Provider Demographics
NPI:1639592322
Name:GARRIQUES, KATHLEEN ANN (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:GARRIQUES
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07832-2030
Mailing Address - Country:US
Mailing Address - Phone:908-475-2498
Mailing Address - Fax:908-475-2498
Practice Address - Street 1:11 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NJ
Practice Address - Zip Code:07832-2030
Practice Address - Country:US
Practice Address - Phone:908-475-2498
Practice Address - Fax:908-475-2498
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ720234133NN1002X, 133V00000X, 133VN1004X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic