Provider Demographics
NPI:1790833929
Name:FRIESZ, MARY CHRISTINA (PHD, RD, CDCES)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CHRISTINA
Last Name:FRIESZ
Suffix:
Gender:F
Credentials:PHD, RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NURSERY LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1572
Mailing Address - Country:US
Mailing Address - Phone:954-296-6300
Mailing Address - Fax:
Practice Address - Street 1:1200 ROUTE 22 STE 2000
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2943
Practice Address - Country:US
Practice Address - Phone:954-296-6300
Practice Address - Fax:908-450-6236
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ714113133V00000X
FLND2239133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN0003Medicare ID - Type UnspecifiedMEDICARE & BC-BS OF FL