Healthcare Provider Details

I. General information

NPI: 1215607023
Provider Name (Legal Business Name): ANNAMARIA LOULOUDIS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MONROE ST STE E518
HOBOKEN NJ
07030-6375
US

IV. Provider business mailing address

1 FOREST AVE
OLD TAPPAN NJ
07675-7108
US

V. Phone/Fax

Practice location:
  • Phone: 917-647-1665
  • Fax:
Mailing address:
  • Phone: 201-741-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: