MEDICARE: MS. DINA MAIEROVITS MS RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1467723445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DINA MAIEROVITS MS RD

Provider Business Mailing Address
First Line	:	9 RAVEN LN
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4968
Country	:	US
Telephone Number	:	732-737-7576
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 RAVEN LN
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4968
Country	:	US
Telephone Number	:	732-737-7576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2012
Last Update Date	:	01/23/2012

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