Provider Demographics
NPI:1972919884
Name:WITTERSCHEIN, AMY L (RD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WITTERSCHEIN
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 1:234 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2810
Mailing Address - Country:US
Mailing Address - Phone:845-649-2491
Mailing Address - Fax:908-436-1109
Practice Address - Street 1:433 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3300
Practice Address - Country:US
Practice Address - Phone:908-436-1002
Practice Address - Fax:908-436-1109
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNOTAPPLICABLE133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered