Healthcare Provider Details

I. General information

NPI: 1205139508
Provider Name (Legal Business Name): OLIVIA ANN CARUSO MA, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 YARDVILLE ALLENTOWN RD STE 3
ALLENTOWN NJ
08501-1866
US

IV. Provider business mailing address

1278 YARDVILLE ALLENTOWN RD STE 3
ALLENTOWN NJ
08501-1866
US

V. Phone/Fax

Practice location:
  • Phone: 609-738-3143
  • Fax:
Mailing address:
  • Phone: 609-738-3143
  • Fax: 609-738-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004071
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: