| |
100 E Main St, Bogota, NJ 07603-1310 | |
(201) 314-8545 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Dietitian, Registered - Nutrition, Pediatric |
Location | 100 E Main St, Bogota, New Jersey |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
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1134622475 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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133VN1004X | Dietitian, Registered - Nutrition, Pediatric | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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Po Box 3382, Teaneck, NJ 07666-9107 Ph: () - | 100 E Main St, Bogota, NJ 07603-1310 Ph: (201) 314-8545 |
Sharon R. Wieder, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 100 E Main St, Bogota, NJ 07603 Phone: 201-314-8545 |