Basic Information
| Provider Information | |||||||||
| NPI: | 1639560998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAVERS | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MEDICAL CENTER WAY | ||||||||
| Address2: | |||||||||
| City: | SOMERS POINT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082442300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096533500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 MEDICAL CENTER WAY | ||||||||
| Address2: | |||||||||
| City: | SOMERS POINT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082442300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096533500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2015 | ||||||||
| LastUpdateDate: | 02/09/2015 | ||||||||
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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 | 133V00000X | 1053024 | NJ | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.