Provider Demographics
NPI:1962653204
Name:FITTERMAN, JODI (RD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:FITTERMAN
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 1:20 THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5564
Mailing Address - Country:US
Mailing Address - Phone:908-903-1670
Mailing Address - Fax:908-903-1672
Practice Address - Street 1:530 GREEN ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2654
Practice Address - Country:US
Practice Address - Phone:732-283-1900
Practice Address - Fax:732-283-1920
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1021057133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered