Provider Demographics
NPI:1457750069
Name:ROGERS, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 SUN VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-3049
Mailing Address - Country:US
Mailing Address - Phone:973-477-7732
Mailing Address - Fax:
Practice Address - Street 1:1116 SUN VALLEY WAY
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-3049
Practice Address - Country:US
Practice Address - Phone:973-477-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist