MEDICARE: NADA ISMAIL MS, RDN

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	86168491	NJ

General Provider Information

NPI Number	:	1972111813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADA ISMAIL MS, RDN

Provider Business Mailing Address
First Line	:	81 LARRY CT
Second Line	:
City	:	DAYTON
State	:	NJ
Zip	:	08810-1313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	81 LARRY CT
Second Line	:
City	:	DAYTON
State	:	NJ
Zip	:	08810-1313
Country	:	US
Telephone Number	:	908-787-5464
Fax Number	:

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

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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