1073360715 NPI number — SHRUTHI E JOHN MS, RD

Table of content: SHRUTHI E JOHN MS, RD (NPI 1073360715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073360715 NPI number — SHRUTHI E JOHN MS, RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHN
Provider First Name:
SHRUTHI
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATHEW
Provider Other First Name:
SHRUTHI
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, RD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073360715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 SPOTSWOOD GRAVEL HILL RD # 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08831-8654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-371-2034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
542 MASTERSON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EWING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08618-1448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-371-2034
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  86058057 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)