Healthcare Provider Details

I. General information

NPI: 1689363699
Provider Name (Legal Business Name): ALINE ASSADOURIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SHERRY LN
SADDLE BROOK NJ
07663-5935
US

IV. Provider business mailing address

15 SHERRY LN
SADDLE BROOK NJ
07663-5935
US

V. Phone/Fax

Practice location:
  • Phone: 201-903-5316
  • Fax:
Mailing address:
  • Phone: 201-903-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86343415
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: