Basic Information
| Provider Information | |||||||||
| NPI: | 1730343153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAMPEL | ||||||||
| FirstName: | SIMONE | ||||||||
| MiddleName: | GILA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RD,CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 FLORAL AVE | ||||||||
| Address2: | |||||||||
| City: | NEW PROVIDENCE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079741557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
| FaxNumber: | 9087906576 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562782597 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2008 | ||||||||
| LastUpdateDate: | 12/08/2016 | ||||||||
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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 | 929599 | PA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.