Individual
DR. MAVIS CAMALITA ERMAKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D., RN., CDE., APN
Contact information
Practice address
741 BROADWAY, NEWARK, NJ 07104-4309
(973) 483-1300
Mailing address
731 LIBERTY CT, PISCATAWAY, NJ 08854-7206
(732) 937-5952
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
0071705
IL
133VN1006X
Metabolic Nutrition Registered Dietitian
717052 (ID#)
IL
163WD0400X
Diabetes Educator Registered Nurse
26NR112011600
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NJ00421400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0143533620
—
NJ
Enumeration date
12/04/2007
Last updated
08/17/2021
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