Healthcare Provider Details

I. General information

NPI: 1780578112
Provider Name (Legal Business Name): KRISTINA WEISER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CROMWELL AVE
STATEN ISLAND NY
10304-3944
US

IV. Provider business mailing address

801 MADISON ST APT 3I
HOBOKEN NJ
07030-6445
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-8100
  • Fax:
Mailing address:
  • Phone: 732-439-9184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86299281
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number012789
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: