Healthcare Provider Details

I. General information

NPI: 1902667157
Provider Name (Legal Business Name): ROBIN ISRAEL RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BROOKSIDE AVE STE 180
AMBLER PA
19002-3436
US

IV. Provider business mailing address

300 BROOKSIDE AVE STE 180
AMBLER PA
19002-3436
US

V. Phone/Fax

Practice location:
  • Phone: 877-842-2425
  • Fax:
Mailing address:
  • Phone: 877-842-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number12711
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: