Provider Demographics
NPI:1447982400
Name:BEBA, BURCU BB (CNS)
Entity type:Individual
Prefix:DR
First Name:BURCU
Middle Name:BB
Last Name:BEBA
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08853-4222
Mailing Address - Country:US
Mailing Address - Phone:630-487-6967
Mailing Address - Fax:
Practice Address - Street 1:17 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08853-4222
Practice Address - Country:US
Practice Address - Phone:630-487-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002982133N00000X
MDDX5432133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist