Provider Demographics
NPI:1932139144
Name:WOZNACK, DARY (RD)
Entity Type:Individual
Prefix:
First Name:DARY
Middle Name:
Last Name:WOZNACK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 BIG BETHEL RD
Mailing Address - Street 2:120
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1906
Mailing Address - Country:US
Mailing Address - Phone:609-713-0099
Mailing Address - Fax:
Practice Address - Street 1:1188 BIG BETHEL RD
Practice Address - Street 2:120
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1906
Practice Address - Country:US
Practice Address - Phone:609-713-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
805389133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100498BVPMedicare ID - Type Unspecified