Healthcare Provider Details

I. General information

NPI: 1073920351
Provider Name (Legal Business Name): ALEXANDRA SCHMIDT RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA MUSARRA RD

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 08/26/2021
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

43 S 3RD ST
SHIP BOTTOM NJ
08008-4736
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4984
  • Fax:
Mailing address:
  • Phone: 609-276-4546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1107155
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1107155
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1107155
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: