Healthcare Provider Details

I. General information

NPI: 1265181770
Provider Name (Legal Business Name): CARISSA NOELLE KOSOFSKY MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34-36 PROGRESS ST STE A6
EDISON NJ
08820-1197
US

IV. Provider business mailing address

1400 E WOODBANK WAY
WEST CHESTER PA
19380-1756
US

V. Phone/Fax

Practice location:
  • Phone: 610-627-4400
  • Fax:
Mailing address:
  • Phone: 610-389-9573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN007360
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number086105418
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: