Provider Demographics
NPI:1639886773
Name:ZWICK, MADALENE MARY (MA, RDN)
Entity Type:Individual
Prefix:MRS
First Name:MADALENE
Middle Name:MARY
Last Name:ZWICK
Suffix:
Gender:F
Credentials:MA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SOOY PLACE RD
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-3562
Mailing Address - Country:US
Mailing Address - Phone:609-234-4743
Mailing Address - Fax:
Practice Address - Street 1:138 SOOY PLACE RD
Practice Address - Street 2:
Practice Address - City:TABERNACLE
Practice Address - State:NJ
Practice Address - Zip Code:08088-3562
Practice Address - Country:US
Practice Address - Phone:609-234-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86057845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered