Provider Demographics
NPI:1447309117
Name:POMPONIO, PATRICIA DIANNE (RD)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DIANNE
Last Name:POMPONIO
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 1:311 MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1223
Mailing Address - Country:US
Mailing Address - Phone:908-322-0025
Mailing Address - Fax:908-322-9955
Practice Address - Street 1:472 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1756
Practice Address - Country:US
Practice Address - Phone:908-322-0025
Practice Address - Fax:908-322-9955
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
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
NJ2056984003OtherCIGNA
NJ7542373OtherAETNA
NJP2664921OtherOXFORD
NJ2241935OtherUHC
NJ058678Medicare ID - Type Unspecified