Basic Information
| Provider Information | |||||||||
| NPI: | 1497170120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCANN | ||||||||
| FirstName: | ROSY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 W GRAND AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013918282 | ||||||||
| FaxNumber: | 2013918299 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 W GRAND AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013918282 | ||||||||
| FaxNumber: | 2013918299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2014 | ||||||||
| LastUpdateDate: | 03/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | 68423105 | NJ | Y | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
No ID Information.