Provider Demographics
NPI:1447461033
Name:NORTH JERSEY NUTRITION
Entity type:Organization
Organization Name:NORTH JERSEY NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CICERO
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,CDE
Authorized Official - Phone:973-538-7791
Mailing Address - Street 1:15 EXETER LN
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6382
Mailing Address - Country:US
Mailing Address - Phone:973-537-7791
Mailing Address - Fax:973-538-7566
Practice Address - Street 1:15 EXETER LN
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6382
Practice Address - Country:US
Practice Address - Phone:973-537-7791
Practice Address - Fax:973-538-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ709515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty