Healthcare Provider Details

I. General information

NPI: 1801432760
Provider Name (Legal Business Name): NICOLE CIUPPA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 LOTZ HILL RD
CLIFTON NJ
07013-2313
US

IV. Provider business mailing address

84 LOTZ HILL RD
CLIFTON NJ
07013-2313
US

V. Phone/Fax

Practice location:
  • Phone: 862-926-7722
  • Fax:
Mailing address:
  • Phone: 862-926-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86088331
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: