Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 38MC00221400 | NJ |
NPI | 1508825837 |
---|---|
Provider Name | Kathleen Erbeck |
First Address | Mendham, NJ 07945-3230 |
Second Address | Mendham, NJ 07945-1546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 27/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
052111 | (02) | NJ |