Provider Demographics
NPI:1912560962
Name:GEORGE, NIKITA (AAS, BSC)
Entity Type:Individual
Prefix:MRS
First Name:NIKITA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:AAS, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CARMEL WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2551
Mailing Address - Country:US
Mailing Address - Phone:732-544-2107
Mailing Address - Fax:
Practice Address - Street 1:145 WYCKOFF RD STE 102
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1879
Practice Address - Country:US
Practice Address - Phone:848-208-2721
Practice Address - Fax:848-208-2506
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist