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General NPI Number Information
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NPI Number | 1134068141
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Entity Type | Individual
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Provider Name | MALIK TIEDT MS, RDN
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Gender | Male
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 45 RIVINGTON ST
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City | NEW YORK
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State | NY
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Zip | 10002-1304
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Country | US
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Telephone | 332-243-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 201 SCHEMMER ST
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City | BURLINGTON
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State | WI
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Zip | 53105-1833
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86392767
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License Number State | NY
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