Healthcare Provider Details

I. General information

NPI: 1801762216
Provider Name (Legal Business Name): MADELINE MARIE BRIGNOLA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

IV. Provider business mailing address

33 INVERNESS DR
DELRAN NJ
08075-1851
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2273
  • Fax:
Mailing address:
  • Phone: 609-760-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86301497
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: