Provider Demographics
NPI:1659541571
Name:AUSTIN, MARTI (MS, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:MARTI
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:MRS
Other - First Name:MARTI
Other - Middle Name:
Other - Last Name:JOHNSON-AUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, CDN
Mailing Address - Street 1:5 HORIZON RD APT 311
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6627
Mailing Address - Country:US
Mailing Address - Phone:201-969-0929
Mailing Address - Fax:201-503-8131
Practice Address - Street 1:5 HORIZON RD APT 311
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6627
Practice Address - Country:US
Practice Address - Phone:201-969-0929
Practice Address - Fax:201-503-8131
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ261454227OtherBLUE CROSS BLUE SHIELD
NJ6839996OtherCIGNA
00002728752OtherUNITED HEALTH CARE
NJ7315856OtherAETNA