Provider Demographics
NPI:1457388159
Name:MATTHEWS-ANTOSIEWICZ, LORRAINE (RD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:MATTHEWS-ANTOSIEWICZ
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 1:80 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1913
Mailing Address - Country:US
Mailing Address - Phone:732-494-1149
Mailing Address - Fax:732-494-8567
Practice Address - Street 1:760 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3224
Practice Address - Country:US
Practice Address - Phone:732-494-1149
Practice Address - Fax:732-494-8567
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ054014Medicare ID - Type Unspecified