Healthcare Provider Details

I. General information

NPI: 1629413703
Provider Name (Legal Business Name): ALEXIS M NEWMAN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 MARKET ST STE 360
PHILADELPHIA PA
19106-2138
US

IV. Provider business mailing address

4258 PARKSIDE AVE APT. 3
PHILADELPHIA PA
19104-1098
US

V. Phone/Fax

Practice location:
  • Phone: 609-534-3008
  • Fax: 855-370-1067
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN004100
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1010174
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: