Basic Information
| Provider Information | |||||||||
| NPI: | 1902306434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ECKARDT | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 S 9TH ST | ||||||||
| Address2: | STE 402 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191076810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159550020 | ||||||||
| FaxNumber: | 2155037577 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CAPITAL WAY STE 356 | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095376000 | ||||||||
| FaxNumber: | 6095376002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2018 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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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 | DN006474 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | N | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.