Basic Information
| Provider Information | |||||||||
| NPI: | 1245779677 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JUNG | ||||||||
| FirstName: | BETHANY | ||||||||
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| Credential: | M.S., R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 254 EASTON AVE | ||||||||
| Address2: | ST. PETER'S UNIVERSITY HOSPITAL DEPT OF NEONATOLOGY | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327458600 | ||||||||
| FaxNumber: | 7327451902 | ||||||||
| Practice Location | |||||||||
| Address1: | 254 EASTON AVE | ||||||||
| Address2: | ST. PETER'S UNIVERSITY HOSPITAL DEPT OF NEONATOLOGY | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327458600 | ||||||||
| FaxNumber: | 7327451902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2017 | ||||||||
| LastUpdateDate: | 02/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | N | Dietary & Nutritional Service Providers | Nutritionist | 133NN1002X | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133VN1004X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric | 133VN1005X | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal | 133VN1006X | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic |
No ID Information.