Provider Demographics
NPI:1245720614
Name:BLUJ, SAMANTHA (RD, LDN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BLUJ
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1806
Mailing Address - Country:US
Mailing Address - Phone:973-975-7702
Mailing Address - Fax:
Practice Address - Street 1:24 VETERANS SQ
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3155
Practice Address - Country:US
Practice Address - Phone:610-783-3600
Practice Address - Fax:610-514-9849
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006022133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered