Individual
BETHAN FANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
89 BIRCH ST, CLOSTER, NJ 07624-1702
(516) 456-1982
Mailing address
89 BIRCH ST, CLOSTER, NJ 07624-1702
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
06/13/2017
Last updated
06/13/2017
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