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NPI Code Detail

MEDICARE: MRS. ELYSA FAITH DINZES R.D

MEDICARE:  MRS. ELYSA FAITH DINZES  R.D
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
1133V00000XRegistered Dietitian005725NY
2133V00000XRegistered Dietitian931147

General Provider Information

NPI Number : 1750317707
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELYSA FAITH DINZES R.D
Provider Business Mailing Address
First Line : 76 N HILLSIDE AVE
Second Line :
City : LIVINGSTON
State : NJ
Zip : 07039-1110
Country : US
Telephone Number : 917-837-0598
Fax Number :
Provider Business Practice Location Address
First Line : 66 W MOUNT PLEASANT AVE STE 205
Second Line :
City : LIVINGSTON
State : NJ
Zip : 07039-2930
Country : US
Telephone Number : 917-837-0598
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 02/04/2020

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