Provider Demographics
NPI:1053570051
Name:BETAR, ELISSA ANNE (RD)
Entity type:Individual
Prefix:MS
First Name:ELISSA
Middle Name:ANNE
Last Name:BETAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MOUNT KEMBLE AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5164
Mailing Address - Country:US
Mailing Address - Phone:973-714-7951
Mailing Address - Fax:
Practice Address - Street 1:700 RAHWAY AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6634
Practice Address - Country:US
Practice Address - Phone:908-378-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered