Provider Demographics
NPI:1265200257
Name:MANIA, KIMBERLY (PSM, RDN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MANIA
Suffix:
Gender:F
Credentials:PSM, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ELLAM DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2610
Mailing Address - Country:US
Mailing Address - Phone:973-970-0618
Mailing Address - Fax:
Practice Address - Street 1:7 ELLAM DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2610
Practice Address - Country:US
Practice Address - Phone:973-970-0618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86110750133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered