Provider Demographics
NPI:1891028692
Name:KAELIN, ELIZABETH SOPHIE (MS, RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SOPHIE
Last Name:KAELIN
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 1:34 FARVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2739
Mailing Address - Country:US
Mailing Address - Phone:914-329-7958
Mailing Address - Fax:
Practice Address - Street 1:34 FARVIEW RD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2739
Practice Address - Country:US
Practice Address - Phone:914-329-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01023534133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered