Active NPI
Nicole Fuller
- Registered Dietitian
- Glen Rock, NJ
National Provider Identifier
1922615210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 11 Austin PL
Glen Rock, NJ 07452-1701 - Phone
- (201) 739-9161
- NPI assigned
- Sep 30, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
11 Austin PL
Glen Rock, NJ 07452-1701
Mailing address
11 Austin PL
Glen Rock, NJ 07452-1701
Phone (201) 739-9161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220915001777 | NJ | Practitioner - Registered Dietitian Or Nutrition Professional | 6709261456 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601424000000",
"number": "1922615210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 AUSTIN PL",
"city": "GLEN ROCK",
"state": "NJ",
"postal_code": "074521701",
"telephone_number": "201-739-9161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 AUSTIN PL",
"city": "GLEN ROCK",
"state": "NJ",
"postal_code": "074521701",
"telephone_number": "201-739-9161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-30",
"last_updated": "2020-09-30",
"certification_date": "2020-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Rock, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.