Healthcare Provider Details

I. General information

NPI: 1346104023
Provider Name (Legal Business Name): LEA MARRUS RIFKIN MS, RD, LDN, RYT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PEMBROKE DR
PALM BEACH GARDENS FL
33418-4611
US

IV. Provider business mailing address

130 PEMBROKE DR
PALM BEACH GARDENS FL
33418-4611
US

V. Phone/Fax

Practice location:
  • Phone: 201-693-5358
  • Fax:
Mailing address:
  • Phone: 201-693-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND10813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: