Provider Demographics
NPI:1558152843
Name:BACKUS, MORGEN-ASHLEE (CNS, LDN)
Entity type:Individual
Prefix:
First Name:MORGEN-ASHLEE
Middle Name:
Last Name:BACKUS
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 DICKERSON ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1208
Mailing Address - Country:US
Mailing Address - Phone:856-628-6679
Mailing Address - Fax:
Practice Address - Street 1:60 DICKERSON ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1208
Practice Address - Country:US
Practice Address - Phone:856-628-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN009026133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist